Jiang Tangxing, Sun Yijun, Zhang Huidan, Zhang Qirui, Tang Shuyao, Niu Xu, Guo Yunyun, Li Ke, Chen Yuguo, Xu Feng
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Medical and Pharmaceutical Basic Research Innovation Center of Emergency and Critical Care Medicine, China's Ministry of Education, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Department of Critical Care Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Medical and Pharmaceutical Basic Research Innovation Center of Emergency and Critical Care Medicine, China's Ministry of Education, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
Resuscitation. 2025 Aug 5:110745. doi: 10.1016/j.resuscitation.2025.110745.
To determine whether dynamically increasing both chest compression depth and rate in response to real-time physiologic feedback-guided by end-tidal CO (ETCO) alone or in combination with diastolic blood pressure (DBP)-improves resuscitation outcomes compared with standard cardiopulmonary resuscitation (CPR) with fixed compression mechanics, in a porcine ventricular fibrillation (VF) arrest model.
Conventional "one-size-fits-all" CPR employs fixed compression depth and rate, failing to adapt to individual physiologic needs. ETCO serves as a surrogate for pulmonary perfusion, while DBP reflects myocardial perfusion. However, the combined use of ETCO and DBP as dual physiologic targets to guide dynamic adjustment of compression depth and rate during CPR has not been previously studied, and its efficacy remains unknown.
Thirty healthy Landrace pigs (14-16 weeks old, 35-40 kg) underwent 10 min of untreated VF. Animals were randomized to one of three CPR strategies (n = 10 per group): (1) Standard CPR: fixed compression depth (5 cm) and rate (100 compressions per minute); (2) ETCO-guided CPR: adjustments every 30 s to maintain ETCO ≥ 10 mmHg; (3) Combined-guided CPR: adjustments every 30 s to maintain both ETCO ≥ 10 mmHg and DBP ≥ 30 mmHg. Defibrillation and epinephrine were administered per protocol. Resuscitation was continued for up to 20 min or until ROSC was achieved. Primary outcome was 24-hour survival. Secondary outcomes included ROSC, neurological outcomes, and hemodynamic parameters. Group comparisons used one-way ANOVA, Kruskal-Wallis, Fisher's exact test, and log-rank test. Repeated measures were analyzed using generalized estimating equations and linear mixed-effects models.
Return of spontaneous circulation (ROSC) rates were 100 %, 90 %, and 50 % in Combined-guided, ETCO-guided, and Standard groups, respectively. Twenty-four-hour survival was 80 %, 50 %, and 20 % (Combined vs. Standard, p = 0.023; ETCO vs. Standard, p = 0.038; Combined vs. ETCO, p = 0.162). Combined guidance yielded superior Cerebral Performance Category scores (median 1.0 vs. 3.0; p = 0.022) and lower S100B levels (3585 vs. 4216 pg/mL; p = 0.022), while differences between Combined and ETCO groups did not reach significance. Highest ETCO (16.1 ± 0.8 mmHg), DBP (32.0 ± 0.5 mmHg), mean arterial pressure (36.7 ± 0.5 mmHg), and coronary perfusion pressure (22.5 ± 0.5 mmHg) were shown with Combined-guided CPR. No increase in major injuries was observed.
Physiologic-feedback CPR-achieved by dynamically adjusting both compression depth and rate based on ETCO and DBP targets-significantly improved survival, neurological outcome, and hemodynamics compared to standard CPR in this porcine VF cardiac arrest model. Although combined ETCO and DBP guidance resulted in significantly better physiological perfusion parameters compared to ETCO guidance alone, observed differences in survival and neurological outcomes between these two groups did not reach statistical significance.
在猪心室颤动（VF）骤停模型中，确定与采用固定按压机制的标准心肺复苏（CPR）相比，仅根据呼气末二氧化碳分压（ETCO₂）或联合舒张压（DBP）进行实时生理反馈动态增加胸外按压深度和速率是否能改善复苏结局。
传统的“一刀切”CPR采用固定的按压深度和速率，无法适应个体生理需求。ETCO₂可作为肺灌注的替代指标，而DBP反映心肌灌注。然而，此前尚未研究将ETCO₂和DBP联合用作双重生理靶点以指导CPR期间按压深度和速率的动态调整，其疗效仍不明确。
30只健康的长白猪（14 - 16周龄，35 - 40千克）经历10分钟未经处理的VF。动物被随机分为三种CPR策略之一（每组n = 10）：（1）标准CPR：固定按压深度（5厘米）和速率（每分钟100次按压）；（2）ETCO₂指导的CPR：每30秒调整一次以维持ETCO₂≥10 mmHg；（3）联合指导的CPR：每30秒调整一次以维持ETCO₂≥10 mmHg且DBP≥30 mmHg。按照方案给予除颤和肾上腺素。复苏持续长达20分钟或直至实现自主循环恢复（ROSC）。主要结局是24小时生存率。次要结局包括ROSC、神经学结局和血流动力学参数。组间比较采用单因素方差分析、Kruskal - Wallis检验、Fisher精确检验和对数秩检验。重复测量采用广义估计方程和线性混合效应模型进行分析。
联合指导组、ETCO₂指导组和标准组的自主循环恢复（ROSC）率分别为100%、90%和50%。24小时生存率分别为80%、50%和20%（联合指导组与标准组相比，p = 0.023；ETCO₂指导组与标准组相比，p = 0.038；联合指导组与ETCO₂指导组相比，p = 0.162）。联合指导产生了更好的脑功能分类评分（中位数1.0对3.0；p = 0.022）和更低的S100B水平（3585对4216 pg/mL；p = 0.022），而联合指导组与ETCO₂指导组之间的差异未达到显著水平。联合指导的CPR显示出最高的ETCO₂（16.1±0.8 mmHg）、DBP（32.0±0.5 mmHg）、平均动脉压（36.7±0.5 mmHg）和冠状动脉灌注压（22.5±0.5 mmHg）。未观察到重大损伤增加。
在该猪VF心脏骤停模型中，与标准CPR相比，基于ETCO₂和DBP靶点动态调整按压深度和速率实现的生理反馈CPR显著改善了生存率、神经学结局和血流动力学。尽管与单独的ETCO₂指导相比，联合ETCO₂和DBP指导导致了明显更好的生理灌注参数，但这两组在生存率和神经学结局方面观察到的差异未达到统计学意义。
