Reply to: In a paediatric animal model of cardiac arrest: Is diastolic blood pressure associated with survival during resuscitation?

摘要

To the Editor, Thank you for the opportunity to reply to the letter by Dr. Manrique et al. We appreciate their suggestion to expand the investigation of the association of hemodynamic data during cardiopulmonary resuscitation (CPR) with survival to include the systolic arterial blood pressure (SBP). Our interest in hemodynamic data during CPR has been to compare the effects of ETCO2-guided CPR with those of standard CPR in initial studies. In those studies, we chose parameters associated with three perfusion pressures during CPR that included: cerebral perfusion, mean arterial blood pressure (MAP) — mean intracranial pressure (ICP); systemic perfusion, MAP — mean central venous pressure (CVP); and myocardial (or coronary) perfusion, diastolic arterial blood pressure (DBP) — diastolic CVP. Unfortunately, these perfusion pressures do not include the measurement of SBP. The cohort of animals that received 10min of basic life support (BLS) in our study underwent a combination of asphyxia and fibrillation arrest. The addition of fibrillation arrest to asphyxia prevented return of spontaneous circulation (ROSC) during BLS so that ETCO2 and hemodynamic values could be captured without concern for including animals that achieved ROSC. The addition of fibrillation meant that ROSC was only achievable during advanced life support (ALS). Therefore, we believe it is less likely that the difference in DBP between survivors and non-survivors in our study was secondary to early ROSC.