Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Resuscitation. 2023 Oct;191:109950. doi: 10.1016/j.resuscitation.2023.109950. Epub 2023 Aug 25.
Develop a novel, physiology-based measurement of duty cycle (Arterial Blood Pressure-Area Duty Cycle [ABP-ADC]) and evaluate the association of ABP-ADC with intra-arrest hemodynamics and patient outcomes.
This was a secondary retrospective study of prospectively collected data from the ICU-RESUS trial (NCT02837497). Invasive arterial waveform data were used to derive ABP-ADC. The primary exposure was ABP-ADC group (<30%; 30-35%; >35%). The primary outcome was systolic blood pressure (sBP). Secondary outcomes included intra-arrest physiologic goals, CPR quality targets, and patient outcomes. In an exploratory analysis, adjusted splines and receiver operating characteristic (ROC) curves were used to determine an optimal ABP-ADC associated with improved hemodynamics and outcomes using a multivariable model.
Of 1129 CPR events, 273 had evaluable arterial waveform data. Mean age is 2.9 years + 4.9 months. Mean ABP-ADC was 32.5% + 5.0%. In univariable analysis, higher ABP-ADC was associated with lower sBP (p < 0.01) and failing to achieve sBP targets (p < 0.01). Other intra-arrest physiologic parameters, quality metrics, and patient outcomes were similar across ABP-ADC groups. Using spline/ROC analysis and clinical judgement, the optimal ABP-ADC cut point was set at 33%. On multivariable analysis, sBP was significantly higher (point estimate 13.18 mmHg, CI95 5.30-21.07, p < 0.01) among patients with ABP-ADC < 33%. Other intra-arrest physiologic and patient outcomes were similar.
In this multicenter cohort, a lower ABP-ADC was associated with higher sBPs during CPR. Although ABP-ADC was not associated with outcomes, further studies are needed to define the interactions between CPR mechanics and intra arrest patient physiology.
开发一种新的、基于生理学的节拍测量方法（动脉血压-面积节拍比 [ABP-ADC]），并评估 ABP-ADC 与停搏期间血液动力学和患者结局的相关性。
这是 ICU-RESUS 试验（NCT02837497）前瞻性收集数据的二次回顾性研究。使用有创动脉波形数据推导出 ABP-ADC。主要暴露是 ABP-ADC 组（<30%；30-35%；>35%）。主要结局是收缩压（sBP）。次要结局包括停搏期间的生理目标、CPR 质量目标和患者结局。在探索性分析中，使用调整后的样条和接收者操作特征（ROC）曲线，使用多变量模型确定与改善血液动力学和结局相关的最佳 ABP-ADC。
在 1129 次 CPR 事件中，有 273 次有可评估的动脉波形数据。平均年龄为 2.9 岁+4.9 个月。平均 ABP-ADC 为 32.5%+5.0%。在单变量分析中，较高的 ABP-ADC 与较低的 sBP（p<0.01）和未能达到 sBP 目标（p<0.01）相关。其他停搏期间的生理参数、质量指标和患者结局在 ABP-ADC 组之间相似。使用样条/ROC 分析和临床判断，将最佳 ABP-ADC 切点设定为 33%。在多变量分析中，sBP 在 ABP-ADC<33%的患者中明显更高（点估计 13.18mmHg，95%CI95 5.30-21.07，p<0.01）。其他停搏期间的生理和患者结局相似。
在这个多中心队列中，较低的 ABP-ADC 与 CPR 期间较高的 sBP 相关。尽管 ABP-ADC 与结局无关，但需要进一步的研究来确定 CPR 力学与停搏期间患者生理学之间的相互作用。
