Virtual arterial blood pressure feedback improves chest compression quality during simulated resuscitation

Introduction: Quality chest compressions (CC) are the most important factor in successful cardiopulmonary resuscitation. Adjustment of CC based upon an invasive arterial blood pressure (ABP) display would be theoretically beneficial. Additionally, having one compressor present for longer than a 2-min cycle with an ABP display may allow for a learning process to further maximize CC. Accordingly, we tested the hypothesis that CC can be improved with a real-time display of invasively measured blood pressure and with an unchanged, physically fit compressor. Methods: A manikin was attached to an ABP display derived from a hemodynamic model responding to parameters of CC rate, depth, and compression-decompression ratio. The area under the blood pressure curve over time (AUC) was used for data analysis. Each participant (N = 20) performed 4 CPR sessions: (1) No ABP display, exchange of compressor every 2 min; (2) ABP display, exchange of compressor every 2 min; (3) no ABP display, no exchange of the compressor; (4) ABP display, no exchange of the compressor. Data were analyzed by ANOVA. Significance was set at a p-value < 0.05. Results: The average AUC for cycles without ABP display was 5201 mmHg s (95% confidence interval (CI) of 4804-5597 mmHg s), and for cycles with ABP display 6110 mmHg s (95% CI of 5715-6507 mmHg s) (p < 0.0001). The average AUC increase with ABP display for each participant was 20.2 +/- 17.4% 95 CI (p < 0.0001). Conclusions: Our study confirms the hypothesis that a real-time display of simulated ABP during CPR that responds to participant performance improves achieved and sustained ABP. However, without any real-time visual feedback, even fit compressors demonstrated degradation of CC quality. (C) 2013 Elsevier Ireland Ltd. All rights reserved.