Physiology Guided CPR

Presentation Description / Summary:

Resuscitation guidelines have used a “one size fits all” approach, recommending the same CPR algorithm for all patients. However, recent evidence shows that individualized resuscitation strategies based upon real-time patient data seems promising. New approaches to measuring physiology in real-time during CPR may improve the quality of our resuscitation and guide individualized resuscitation interventions for improved outcomes. Evidence has shown that optimization of coronary perfusion pressure, diastolic blood pressure, and end-tidal carbon dioxide improves outcome in CPR. By titrating resuscitation interventions to maximize these physiologic parameters we may not only improve the rate of return of spontaneous circulation but also reduce post-CPR adverse events. This lecture will review the physiologic targets we aim to optimize during CPR and the specific interventions we can employ based on the individual patient's needs. We will review proposed methods guiding epinephrine dosing incorporating various monitoring techniques and the evidence behind the role of other vasopressors in CPR. We will also explore the evidence behind maximizing the quality of chest compressions using trans-esophageal echocardiography as well as the role for various form of oximetry and impedance threshold device in the arrest setting. Decades of experimental evidence exists in human and animal models to suggest following a physiology-guided approach to CPR.

Learner Outcomes:
- Understand the pathophysiologic rationale for physiology guided CPR