Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Crit Care. 2018 Jun;24(3):143-150. doi: 10.1097/MCC.0000000000000499.
We review the recent advances in physiologic monitoring during cardiac arrest and offer an evidence-based framework for prioritizing physiologic targets during cardiopulmonary resuscitation (CPR).
Current CPR guidelines recommend a uniform approach for all patients in cardiac arrest, but newer data support a precision strategy that uses the individual patient's physiology to guide resuscitation. Coronary perfusion pressure and arterial DBP are associated with survival outcomes in recent animal and human studies. End-tidal carbon dioxide is a reasonable noninvasive alternative, but may be inferior to invasive hemodynamic endpoints. Cerebral oximetry and cardiac ultrasound are emerging physiologic indicators of CPR effectiveness.
Physiologic monitoring can and should be used to deliver precision CPR whenever possible and may improve outcomes after cardiac arrest.
我们回顾了心脏骤停期间生理监测的最新进展，并为心肺复苏（CPR）期间优先考虑生理目标提供了一个基于证据的框架。
目前的 CPR 指南建议对所有心脏骤停患者采用统一的方法，但新的数据支持一种精确策略，该策略使用个体患者的生理状况来指导复苏。最近的动物和人体研究表明，冠状动脉灌注压和动脉舒张压与生存结果相关。呼气末二氧化碳是一种合理的无创替代方法，但可能不如有创血流动力学终点。脑氧饱和度和心脏超声是 CPR 效果的新兴生理指标。
只要有可能，生理监测就可以并且应该用于提供精确的 CPR，并且可能改善心脏骤停后的结果。
