Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest—the PERSEUS resuscitation protocol

Chalkias, Athanasios; Αrnaoutoglou, Eleni; Xanthos, Theodoros

doi:10.1007/s10741-019-09772-7

Cited by 23 publications

(21 citation statements)

References 59 publications

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“…The generation of cardiac output during CPR is mainly based on two complementary theories: the theory of the thoracic pump and the theory of the cardiac pump (Chalkias et al, 2019). The sternal recoil during the decompression phase decreases intrathoracic pressure, and this is crucial to maintaining venous return and therefore cardiac output.…”

Section: Introductionmentioning

confidence: 99%

“…The effectiveness of chest compressions is determined by the restoration of the venous return gradient. This flow depends on the gradient between the mean systemic filling pressure of the venous system and the right atrial pressure (Chalkias et al, 2019). The “suction” effect that favors venous return is generated by the negative pressure created when the chest wall recovers its position during decompression; this is one of the main elements of the “thoracic pump” theory.…”

Section: Introductionmentioning

confidence: 99%

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Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

et al. 2019

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Chest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest. Their quality performance is key to achieving the return of spontaneous circulation. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. STIs produce a decrease in the compliance of the chest wall and lung. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

et al. 2019

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“…However, our swine model simulates the real hemodynamic events of hemorrhagic shock from the onset of pathophysiological manifestations to cardiac arrest, and our results may add to the understanding of Pmsf complexity in critically ill patients. We believe that the findings of this study are important for the understanding of the physiologic basis of goal-directed treatment and the titration of resuscitation efforts to the patient's physiologic response [43].…”

Section: Discussionmentioning

confidence: 91%

Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation

et al. 2020

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Background:Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient's volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf's association with vasopressor-free resuscitation. Methods: Ten healthy Landrace/Large-White piglets aged 10-12 weeks with average weight 20 ± 1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5-7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤ 4 mm Hg. No vasopressors were used. Results: The mean volume of blood removed was 860 ± 20 ml (blood loss, ~61%) and the bleeding time was 43.2 ± 2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09 ± 1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5-7.5 seconds and 3.72±0.23 mm Hg at 55-57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1 ±1.7 minutes and mean administered volume being 394 ±20 ml. Conclusions: For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.

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“…In any case, optimizing Pmsf and venous return is key to improving survival outcomes. A personalized physiology-guided resuscitation protocol recently published considers increase the circulatory volume in patients with pre-arrest CVP < 2 mmHg using PLR [36].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

et al. 2021

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Background There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA). Methods We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1–2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors. Results In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60–82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1–2 (OR 0.9; 95% CI 0.4–2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7–1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8–3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909–1500) vs 1239 mg (IQR 900–1507), p = 0.82] or brain weight [1352 mg (IQR 1227–1457) vs 1380 mg (IQR 1255–1470), p = 0.43] among the 106 autopsies performed. Conclusion In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1–2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest—the PERSEUS resuscitation protocol

Cited by 23 publications

References 59 publications

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

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