Resuscitation · 2026
Diastolic blood pressure and end-tidal carbon dioxide during adult ICU cardiopulmonary resuscitation: association with return of spontaneous circulation.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Singh Akanksha, Kataria Sahil, John Giji, Wosser Tenzin, Ray Sumit
Аннотация
AIM: To evaluate the association of intra-arrest diastolic blood pressure and end-tidal carbon dioxide with return of spontaneous circulation in adult ICU cardiac arrest.
METHODS: This prospective observational study was conducted in an adult medical-surgical ICU over 9 months. Adult patients with an indwelling arterial catheter and mainstream capnography at the time of cardiac arrest were included. Diastolic blood pressure (DBP) and end-tidal carbon dioxide (EtCO2) were recorded at the end of each 2-min CPR cycle. The primary analysis used mean DBP and mean EtCO2 across the CPR episode. Last recorded pre-outcome values were analyzed separately as secondary peri-outcome measures. The primary outcome was ROSC. Associations were assessed using logistic regression, and discrimination was evaluated using receiver operating characteristic curve analysis.
RESULTS: A total of 68 cardiac arrest events from 63 patients were analyzed; ROSC was achieved in 29 events (42.6%). Mean DBP across the CPR episode was higher in events achieving ROSC than in those without ROSC (39 ± 18 vs 24 ± 10 mmHg; mean difference 15 mmHg, 95% CI 8-23; p < 0.001). Mean EtCO2 was also higher in events achieving ROSC (19 ± 5 vs 15 ± 6 mmHg; mean difference 4 mmHg, 95% CI 1-6; p = 0.010). For mean values, DBP showed numerically higher discrimination than EtCO2, but the difference was not statistically significant (AUC 0.78 vs 0.69; DeLong p = 0.30). In secondary peri-outcome analysis, last recorded pre-outcome values had higher AUCs, particularly for DBP (0.96 vs 0.85; DeLong p = 0.04), although this time point was identifiable only after ROSC or termination of resuscitation.
CONCLUSION: In adult ICU cardiac arrest events with simultaneous arterial pressure and capnographic monitoring, both DBP and EtCO2 were associated with ROSC. DBP showed numerically higher discrimination than EtCO2, although this was not statistically significant for mean values across the CPR episode. Last recorded pre-outcome values should be interpreted only as peri-outcome associations and not as real-time predictors or treatment targets. DBP and EtCO2 should be viewed as complementary physiologic markers during CPR.
METHODS: This prospective observational study was conducted in an adult medical-surgical ICU over 9 months. Adult patients with an indwelling arterial catheter and mainstream capnography at the time of cardiac arrest were included. Diastolic blood pressure (DBP) and end-tidal carbon dioxide (EtCO2) were recorded at the end of each 2-min CPR cycle. The primary analysis used mean DBP and mean EtCO2 across the CPR episode. Last recorded pre-outcome values were analyzed separately as secondary peri-outcome measures. The primary outcome was ROSC. Associations were assessed using logistic regression, and discrimination was evaluated using receiver operating characteristic curve analysis.
RESULTS: A total of 68 cardiac arrest events from 63 patients were analyzed; ROSC was achieved in 29 events (42.6%). Mean DBP across the CPR episode was higher in events achieving ROSC than in those without ROSC (39 ± 18 vs 24 ± 10 mmHg; mean difference 15 mmHg, 95% CI 8-23; p < 0.001). Mean EtCO2 was also higher in events achieving ROSC (19 ± 5 vs 15 ± 6 mmHg; mean difference 4 mmHg, 95% CI 1-6; p = 0.010). For mean values, DBP showed numerically higher discrimination than EtCO2, but the difference was not statistically significant (AUC 0.78 vs 0.69; DeLong p = 0.30). In secondary peri-outcome analysis, last recorded pre-outcome values had higher AUCs, particularly for DBP (0.96 vs 0.85; DeLong p = 0.04), although this time point was identifiable only after ROSC or termination of resuscitation.
CONCLUSION: In adult ICU cardiac arrest events with simultaneous arterial pressure and capnographic monitoring, both DBP and EtCO2 were associated with ROSC. DBP showed numerically higher discrimination than EtCO2, although this was not statistically significant for mean values across the CPR episode. Last recorded pre-outcome values should be interpreted only as peri-outcome associations and not as real-time predictors or treatment targets. DBP and EtCO2 should be viewed as complementary physiologic markers during CPR.