Invasive hemodynamic monitoring during cardiopulmonary resuscitation in a community hospital emergency department

Monitoring the effects of resuscitation efforts in a community emergency department are limited primarily to noninvasive techniques. Coronary perfusion pressure (CCP) has been used as a predictor for successful resuscitation. The authors investigated the feasibility of measuring the CPP in a community emergency department and incorporating the CPP into decisions for managing the resuscitation effort. During a 7-month period, the authors prospectively studied 77 nontraumatic, normothermic adults in cardiopulmonary arrest who were treated in the emergency department. Fifty-one patients underwent invasive monitoring and 26 patients entered a control (noninvasive monitoring) group. Successful CPP monitoring was accomplished in 84% of the patients; the average time to obtain an initial CPP was 12.1 +/- 7.3 minutes. Twenty patients had a return of spontaneous circulation, but no patient survived to hospital discharge. There was no significant difference in return of spontaneous circulation between patients in the invasively monitored and the noninvasively monitored group. Coronary perfusion pressure monitoring had a positive influence on the management of three patients. This study showed that CPP monitoring is feasible in a community hospital, but further studies are needed to better define the effects of CPP in resuscitation effort outcome.