Myocardial
perfusion pressure: A predictor of 24-hour survival during prolonged cardiac
arrest in dogs
Karl B. Kern
a,
Gordon A. Ewy , William D. Voorhees b,
Charles F. Babbs b
and Willis A. Tacker b
a The Section of Cardiology, Department of Internal
Medicine, University of Arizona College of Medicine, the Veterans
Administration Medical Center and the University Medical Center, Tucson, AZ
85723, USA
b Biomedical Engineering Center and Department of
Veterinary Physiology and Pharmacology, Purdue University, West Lafayette,
Indiana, U.S.A.
Received 9 September 1987; Revised 24 November 1987; accepted 30
November 1987. Available online
Myocardial perfusion pressure, defined as
the aortic diastolic pressure minus the right atrial
diastolic pressure, correlates with coronary blood flow during cardiopulmonary
resuscitation (CPR) and predicts initial resuscitation success. Whether this hemodynamic parameter can predict 24-h survival is not
known. We examined the relationship between myocardial perfusion pressure and
24-h survival in 60 dogs that underwent prolonged (20 min) ventricular
fibrillation and CPR. Forty-two (70%) animals were initially resuscitated and
20 (33%) survived for 24 h. Myocardial perfusion pressure was significantly
greater when measured at 5, 10, 15 and 20 min of ventricular fibrillation in
the resuscitated animals than in the non-resuscitated animals (P <
0.01). Likewise, the myocardial perfusion pressure was also greater in the
animals that survived 24 h than in animals that were resuscitated, but died
before 24 h (P < 0.02). Myocardial perfusion pressure measured after
10 min of CPR was 11 ± 2 mmHg in animals never resuscitated, 20 ± 3 mmHg in
those resuscitated that died before 24 h and 29 ± 2 mmHg in those that survived
24 h (P < 0.05). A myocardial perfusion pressure at 10 min of CPR of
20 mmHg or less is an excellent predictor of poor survival (negative predictive
VALUE = 96%). Myocardial perfusion pressure is a useful index of CPR
effectiveness and therefore may be a useful guide in helping to optimize
resuscitation efforts.
Author Keywords: Author Keywords: Cardiopulmonary resuscitation;
Myocardial perfusion pressure; Cardiac arrest survival