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Data Tables

Cardiovascular Critical Care II

Patrick M. Wieruszewski ~3 min read Module 12 of 20

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Cardiovascular Critical Care II

xi.

The use of extracorporeal CPR is emerging as a therapy for those who fail conventional

CPR. The current data seems promising in benefiting neurologic outcomes but is limited by

bias and quality (Circulation 2019;140:e881-e894; Circulation 2024;149:e254-73). Current

recommendation is that extracorporeal CPR may be considered for selected patients as rescue

therapy when conventional CPR efforts are failing in settings in which it can be successfully

implemented by skilled providers.

xii.

Partial pressure of end-tidal CO2 (PETCO2), coronary perfusion pressure (aortic diastolic

pressure minus right atrial diastolic pressure), arterial relaxation pressure, regional cerebral

oxygenation and central venous oxygen saturation (Scvo2) may correlate with cardiac output

and myocardial blood flow during CPR. Threshold values have been reported at which ROSC

is rarely achieved, and an abrupt increase in any of these variables is a sensitive indicator of

ROSC (Table 1 - Circulation 2015;132(suppl 2):S315-S367; Ann Emerg Med 1992;21:1094-101;

JAMA 1990;263:1106-13; Am J Emerg Med 1985;3:11-4; J Emerg Med 2010;38:614-21; Crit

Care 2008;12:R115; Crit Care Med 2016;44:1663-74).

Table 1. Useful Physiological Variables During CPR

Variable

ROSC Rarely Achieved

PETCO2

< 10 mm Hg

Coronary perfusion pressure

< 15–20 mm Hg

Arterial relaxation (diastolic) pressure

< 20–40 mm Hg

Regional cerebral oxygenation

< 25%

Scvo2

< 30%

Patient Case

A.C., a 50-year-old man with a history of gastroesophageal reflux disorder and chronic obstructive pulmonary

disease, was admitted for shortness of breath, palpitations, and presumed exacerbation of his lung disease.

On hospital admission day 4, A.C. has a witnessed cardiac arrest on the family medicine unit. The emergency

response team of which you are part is called, and when you arrive, the bedside nurse has already begun

chest compressions. Which insight would be best shared regarding chest compressions for A.C.?

A.Because the nurse has already begun chest compressions, she should continue chest compressions for

the duration of CPR.

B.Compressions increase intrathoracic pressure and directly compress the heart, which can generate car-

diac output and deliver oxygen.

C.Because increasing the intrathoracic pressure is vital to oxygen delivery, chest recoil is unnecessary and

should be avoided.

D.Number of chest compressions per minute does not affect outcomes, so pulse check and line and airway

placements can interrupt chest compressions.

A - Airway

To place an artificial airway in patients without an advanced airway, use the head-tilt, chin-

lift technique if patients have no evidence of head or neck trauma and the jaw thrust alone if

cervical spine injury is suspected (JACEP 1976;5:588-90; JAMA 1960;172:812-5) (see “Rescue

Breaths” following).

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