Both devices provided effective hemodynamic support during cardiac arrest in the catheterization laboratory, and although Corpuls produced greater increases in diastolic and MAP from baseline, no clear device superiority was demonstrated.
Abstract
Mechanical cardiopulmonary resuscitation (mCPR) devices are increasingly used during percutaneous coronary intervention (PCI) in intracardiac arrest patients. However, the optimal invasive hemodynamic parameter to guide mCPR remains unclear. This study compared the hemodynamic performance of two devices, LUCAS and Corpuls, using invasive blood pressure (IBP) measurements during early mCPR. This retrospective, single-center study included adult patients undergoing catheterization laboratory procedures (2021-2024). Invasive blood pressure readings were recorded every 10 seconds during initial manual CPR and the first 5 minutes of mCPR. Hemodynamic parameters and return of spontaneous circulation (ROSC) outcomes were analyzed. Twenty-five cases were analyzed (15 LUCAS, 10 Corpuls; mean age 79.1 ± 14 years; 56% male). Both devices generated higher IBP compared with manual CPR. Corpuls produced greater increases from the manual CPR baseline in ΔDBP (delta diastolic blood pressure) and ΔMAP (delta mean arterial blood pressure), whereas ΔSBP (delta systolic blood pressure) did not differ significantly. Variability metrics were comparable, and ROSC rates were similar. Both devices provided effective hemodynamic support during cardiac arrest in the catheterization laboratory. Although Corpuls produced greater increases in diastolic and MAP from baseline, no clear device superiority was demonstrated. Larger prospective studies are required to define optimal hemodynamic targets during mechanical CPR.
The EVERDAC trial challenges routine placement, showing that in critically ill patients with shock, deferring arterial catheterization and using initial noninvasive monitoring with an automated brachial cuff was noninferior to early invasive monitoring for 28-day mortality.
Juan Pablo Arreola Nuñez· Critical Care & Emergenc...· 0 citations
AIM
Arterial blood gas analysis (ABGA) is not routinely performed during cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA), and is not recommended by current guidelines. This preplanned secondary analysis of the Augmented-Medication CardioPulmonary Resuscitation (AMCPR) trial evaluated whether intra-arrest PaO2 was associated with sustained return of spontaneous circulation (ROSC).
METHODS
Adult OHCA patients treated at a tertiary emergency department were included. ABGA samples were obtained immediately after ultrasound-confirmed arterial catheterization and 10 and 20 min after the start of ED resuscitation; parameters included pH, PaO2, PaCO2, bicarbonate (HCO3-), and lactate. PaO2 at the protocol-defined 10-min time point was the primary exposure and sustained ROSC the outcome; other parameters and sampling times were examined as secondary exploratory analyses.
RESULTS
Among 251 patients, 93 (37.1%) achieved sustained ROSC and 135 had a 10-min sample. In the primary analysis of these 135 patients, higher PaO2 at 10 min was independently associated with sustained ROSC (adjusted odds ratio 1.02; 95% CI 1.01-1.02). In secondary exploratory analyses, optimal cut-offs were PaO2 >60 mmHg and PaCO2 <70 mmHg, whereas pH and lactate showed no consistent pattern. Twenty patients (8.0%) survived to discharge and 2 (0.8%) had a favorable neurological outcome.
CONCLUSION
During monitored ED resuscitation for OHCA, higher intra-arrest PaO2 was associated with sustained ROSC, although this association was only partly separable from resuscitation duration. Arterial line placement during CPR may provide physiologic information beyond hemodynamic monitoring.
June-sung Kim, Youn-Jung Kim, W. Kim· Resuscitation· 0 citations
Abstract Objective To compare the agreement of hemodynamic parameters measured by Swan-Ganz catheter and thoracic electrical bioimpedance (TEB) in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG), and to evaluate the clinical application value of TEB in perioperative hemodynamic monitoring. Methods A total of 42 CHD patients who underwent off-pump coronary artery bypass grafting (OPCABG) in the Department of Cardiac Surgery, Binzhou Medical University Hospital, from August 2021 to March 2022 were enrolled in this prospective observational study. All patients received continuous hemodynamic monitoring using both TEB and Swan-Ganz catheter throughout the surgical procedure, with simultaneous data collection. Cardiac output (CO), Stroke volume (SV), stroke volume index (SI), and end-diastolic volume (EDV) were recorded at two key time points (before thoracotomy and after chest closure) for statistical analysis. Results Bland-Altman corrected for repeated measurements revealed mean bias of −0.30 L/min (CO), −9.10 mL (SV), −5.10 mL/m2 (SI), and 69.80 mL (EDV); corresponding 95% limits of agreement (LOA) were −2.50 to 1.80 L/min, −47.70 to 29.60 mL, −27.10 to 16.80 mL/m2, and −55.45 to 195.10 mL respectively. The 95% LOA of all four indices fell within predefined clinical acceptable thresholds, whereas paired t-test demonstrated statistically significant inter-method differences for all measured parameters. Conclusion TEB serves as a reliable, non-invasive tool for real-time continuous trend monitoring of CO, SV, SI, and EDV in critically ill surgical patients, especially those for whom invasive monitoring is contraindicated. This study supports the clinical application of TEB as an alternative or supplementary method for perioperative hemodynamic assessment in OPCABG patients.
Wei-Ling Wang, Xiangmei Bu, Quan-Yi Zhang et al.· Annals medicus· 0 citations
OBJECTIVES
Minimally invasive cardiac output (CO) monitoring technologies lack validation in the adolescent population. We aimed to test the accuracy and precision of the FloTrac arterial pressure cardiac output (APCO) and ClearSight photoplethysmography cardiac output (PPGCO; Edwards Lifesciences, Irvine, CA) technologies in adolescents undergoing elective cardiac catheterization.
DESIGN
Prospective, single-arm, nonrandomized, observational study.
SETTING
Cardiac catheterization laboratory at three freestanding pediatric hospitals in the United States.
PATIENTS
Adolescent patients 12-18 years of age undergoing surveillance cardiac catheterization after heart transplantation.
INTERVENTIONS
Swan-Ganz pulmonary artery catheterization with the intermittent thermodilution CO (iCO) technique was used as the gold standard for CO measurements. APCO was measured using an existing femoral arterial sheath, and PPGCO was measured utilizing a volumetric cuff placed on the finger of the upper extremities. Two sets of simultaneous iCO, APCO, and PPGCO measurements were compared. Bias and level of concordance were assessed using Bland-Altman analysis.
MEASUREMENTS AND MAIN RESULTS
Out of the 89 subjects enrolled, 73 underwent measurements and provided a total of 60 sets of measurements for each device. The median age was 16 years (interquartile range [IQR], 14-17 yr) with a median body surface area of 1.6 m2 (IQR, 1.5-1.8 m2). The median averaged intermittent cardiac index was 2.7 L/min/m2 (IQR, 2.3-3.1 L/min/m2). FloTrac APCO mean bias was 0.32 L/min/m2 (IQR, 0.20-0.44 L/min/m2) with a precision of 0.70 L/min/m2 (IQR, 0.58-0.82 L/min/m2). ClearSight PPGCO mean bias was 0.28 L/min/m2 (95% CI, 0.16-0.41 L/min/m2) with a precision of 0.71 L/min/m2 (95% CI, 0.59-0.84 L/min/m2). No serious adverse events were reported related to the devices.
CONCLUSIONS
The minimally and noninvasive CO measurements with FloTrac and ClearSight APCO show acceptable bias and precision under standardized elective clinical conditions in an adolescent pediatric population, making them useful tools in the routine clinical management of critically ill children.
S. Tume, Michael L. O’Byrne, Curt Fudge et al.· Pediatric Critical Care Medi...· 0 citations
Femoral artery ultrasound has the potential to be utilized for hemodynamic monitoring during cardiopulmonary resuscitation (CPR).
This study evaluated the correlation between femoral artery diameter and established physiologic parameters during CPR, as well as the association between femoral artery diameter and return of spontaneous circulation (ROSC).
A secondary analysis of a porcine ventricular fibrillation cardiac arrest model was conducted. The primary exposure was femoral artery diameter measured via ultrasound every 2 minutes during cardiac arrest. Physiologic parameters including diastolic blood pressure (DBP), end‐tidal carbon dioxide (ETCO2), coronary perfusion pressure (CoPP), and cerebral perfusion pressure (CePP) were recorded throughout the experiment. The primary outcome was the mean difference in femoral artery diameter between pigs with and without ROSC, analyzed using a linear mixed model. Correlation coefficients were calculated using a mixed‐model approach.
A total of 199 data points from 22 pigs were analyzed, with a median femoral artery diameter of 2.6 mm (interquartile range: 2.1–3.5). Femoral artery diameter was significantly larger in pigs with ROSC than in those without ROSC (mean difference [95% confidence interval (CI)]: 0.9 mm [0.3–1.4],
p
‐value = 0.004). Although DBP significantly differed between ROSC and non‐ROSC groups, ETCO2 levels did not. Femoral artery diameter showed moderate correlations with DBP (
r
= 0.66 [95% CI: 0.56–0.75]), CoPP (
r
= 0.64 [95% CI: 0.52–0.76]), and CePP (
r
= 0.69 [95% CI: 0.60–0.77]).
Femoral artery diameter exhibited significant correlations with physiologic parameters, including DBP, CoPP, and CePP, and a larger diameter was associated with ROSC. Given its ease of measurement with minimal CPR interruption, femoral artery diameter may serve as a reliable indicator of CPR quality.
H. Kang, D. Choi, Ki Hong Kim et al.· Hong Kong Journal of Emergen...· 0 citations
Autonomous or semi‑autonomous "autonomous vascular access" (AVA) platforms have the promise to standardize technique, accelerate placement by a wider range of providers, extend cannulation capability to austere settings, and reduce complication‑related morbidity.
Joel Grunhut, Patrick Walker, Meredith Lackie et al.· Military Medicine· 0 citations
