Synopsis

Per-Olav Berve is a Norwegian anaesthesiologist who works for the Oslo air ambulance and in-hospital at the Oslo University Hospital. He is currently wrapping up a PhD on CPR physiology, focusing on multimodal monitoring. His main project is a OHCA study on mechanical active compression-decompression CPR.

Tailored or targeted CPR and resuscitation is a very popular concept with a lot of traction currently. In this talk from The Big Sick in Zermatt in 2018, Per details insights from his research that cautions us when choosing targets to titrate to. There’s more to the eye than sheer numbers, it turns out. Learn how your pattern recognition abilities may beat any monitor on the market.

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Scott Weingart recently did an emcrit podcast with PO specifically on this topic of diastolic pressure targets during CPR. A lot more to be learned there including advice on how to apply this in practice.

Find Per Olav here

References

Blood pressures

Kern, K. B., Hilwig, R., & Ewy, G. A. (1994). Retrograde coronary blood flow during cardiopulmonary resuscitation in swine: intracoronary Doppler evaluation. American Heart Journal, 128(3), 490–499.
Otlewski, M. P., Geddes, L. A., Pargett, M., & Babbs, C. F. (2009). Methods for calculating coronary perfusion pressure during CPR. Cardiovascular Engineering (Dordrecht, Netherlands), 9(3), 98–103. http://doi.org/10.1007/s10558-009-9079-y
Duchateau, F.-X., Gueye, P., Curac, S., Tubach, F., Broche, C., Plaisance, P., et al. (2010). Effect of the AutoPulse™ automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation. Intensive Care Medicine, 36(7), 1256–1260. http://doi.org/10.1007/s00134-010-1784-x
Marquez, A. M., Morgan, R. W., Ross, C. E., Berg, R. A., & Sutton, R. M. (2018). Physiology-directed cardiopulmonary resuscitation. Current Opinion in Critical Care, Publish Ahead of Print, 1–8. http://doi.org/10.1097/MCC.0000000000000499
Paradis, N. A., Martin, G. B., Goetting, M. G., Rosenberg, J. M., Rivers, E. P., Appleton, T. J., & Nowak, R. M. (1989). Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. Insights into mechanisms. Circulation, 80(2), 361–368.
Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., et al. (2013). Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association. Circulation, 128(4), 417–435. http://doi.org/10.1161/CIR.0b013e31829d8654
Duchatelet, C., Kalmar, A. F., Monsieurs, K. G., & Hachimi-Idrissi, S. (2018). Chest compressions during ventilation in out-of- hospital cardiac arrest cause reversed airflow. Resuscitation. http://doi.org/10.1016/j.resuscitation.2018.03.035
Paradis, N. A., Martin, G. B., Goetting, M. G., Rosenberg, J. M., Rivers, E. P., Appleton, T. J., & Nowak, R. M. (1989). Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. Insights into mechanisms. Circulation, 80(2), 361–368.

CPR mechanics

Teran, F., Dean, A. J., Centeno, C., Panebianco, N. L., Zeidan, A. J., Chan, W., & Abella, B. S. (2019). Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department. Resuscitation, 137, 140–147. http://doi.org/10.1016/j.resuscitation.2019.02.013
Cho, S., Oh, W. S., Chon, S.-B., Kim, S., & Hwang, K. (2018). Theoretical personalized optimum chest compression point can be determined using posteroanterior chest radiography. Resuscitation, 128, 97–105. http://doi.org/10.1016/j.resuscitation.2018.05.007
Catena, E., Ottolina, D., Fossali, T., Rech, R., Borghi, B., Perotti, A., et al. (2019). Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest. Resuscitation, 138, 8–14. http://doi.org/10.1016/j.resuscitation.2019.02.027
Hwang, S. O., Zhao, P. G., Choi, H. J., Park, K. H., Cha, K. C., Park, S. M., et al. (2009). Compression of the left ventricular outflow tract during cardiopulmonary resuscitation. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16(10), 928–933. http://doi.org/10.1111/j.1553-2712.2009.00497.x
Steinberg, M. T., Olsen, J.-A., Eriksen, M., Neset, A., Norseng, P. A., Kramer-Johansen, J., et al. (2018). Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 31. http://doi.org/10.1186/s13049-018-0496-z
Sunde, K., Wik, L., Naess, P. A., Ilebekk, A., Nicolaysen, G., & STEEN, P. A. (1998). Effect of different compression–decompression cycles on haemodynamics during ACD-CPR in pigs. Resuscitation, 36(2), 123–131.

The CO2 problem

Grieco, D. L., Brochard, L., Drouet, A., Telias, I., Delisle, S., Bronchti, G., et al. (2018). Intrathoracic Airway Closure Impacts CO 2Signal and Delivered Ventilation During Cardiopulmonary Resuscitation. American Journal of Respiratory and Critical Care Medicine, rccm.201806–1111OC–40. http://doi.org/10.1164/rccm.201806-1111OC
Leturiondo, M., Ruiz de Gauna, S., Ruiz, J. M., Julio Gutiérrez, J., Leturiondo, L. A., González-Otero, D. M., et al. (2017). Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation. Resuscitation, 124, 63–68. http://doi.org/10.1016/j.resuscitation.2017.12.013
Leturiondo, M., Gauna, S. R. de, Ruiz, J., Gutiérrez, J. J., Leturiondo, L. A., Bastida, J. M., & Daya, M. (2017). Reliability of ventilation guidance using capnography during ongoing chest compressions in out-of-hospital cardiopulmonary resuscitation. Resuscitation, 118, e18–e19. http://doi.org/10.1016/j.resuscitation.2017.08.055
Raimondi, M., Savastano, S., Pamploni, G., Molinari, S., Degani, A., & Belliato, M. (2016). End-tidal carbon dioxide monitoring and load band device for mechanical cardio-pulmonary resuscitation: Never trust the numbers, believe at the curves. Resuscitation, 103, 1–2. http://doi.org/10.1016/j.resuscitation.2016.03.003

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Mads Astvad

Scandinavian paediatric anaesthetist / intensivist.
PHARM, ED, OR, ICU.
Digital MedEd
Co-founder scanFOAM.org
Co-organiser CphCC & TBS-Zermatt (aka The Big Sick)
Medical lead REPEL (resilience in pediatric emergency life support)
Web dev SSAI.info