N. A. Paradis, G.
B. Martin, E. P. Rivers, M. G. Goetting, T. J.
Appleton, M. Feingold and R. M. Nowak
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202.
Coronary perfusion pressure (CPP), the
aortic-to-right atrial pressure gradient
during the relaxation phase of cardiopulmonary resuscitation, was measured
in 100 patients with cardiac arrest. Coronary perfusion pressure and
other variables were compared in patients with and without return of spontaneous
circulation (ROSC). Twenty-four patients had ROSC. Initial CPP (mean
+/- SD) was 1.6 +/- 8.5 mm Hg in patients without ROSC and 13.4 +/- 8.5
mm Hg in those with ROSC. The maximal CPP measured was 8.4 +/- 10.0 mm Hg
in those without ROSC and 25.6 +/- 7.7 mm Hg in those with ROSC. Differences
were also found for the maximal aortic relaxation pressure, the compression-phase
aortic-to-right atrial gradient, and the arterial
PO2. No patient with an initial CPP less than 0 mm Hg had ROSC. Only
patients with maximal CPPs of 15 mm Hg or
more had ROSC, and the fraction of patients with ROSC increased as
the maximal CPP increased. A CPP above 15 mm Hg did not guarantee
ROSC, however, as 18 patients whose CPPs were 15 mm
Hg or greater did not resuscitate. Of variables measured, maximal
CPP was most predictive of ROSC, and all CPP measurements were more
predictive than was aortic pressure alone. The study substantiates
animal data that indicate the importance of CPP during cardiopulmonary
resuscitation.