Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous...

Area of Science:

• Cardiology
• Emergency Medicine
• Critical Care Medicine

Background:

• Current cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions at the center of the chest.
• Approximately 50% of out-of-hospital cardiac arrest (OHCA) patients experience aortic valve (AV) compression during CPR, potentially obstructing blood flow.

Purpose of the Study:

• To investigate the impact of uncompressed versus compressed aortic valves on resuscitation outcomes in adult OHCA patients.
• To elucidate the relationship between AV compression and return of spontaneous circulation (ROSC).

Main Methods:

• Prospective observational cohort study at a single center.
• Adult OHCA patients undergoing resuscitative transesophageal echocardiography (TEE) were categorized into AV uncompressed or AV compressed groups.
• Primary outcome was sustained ROSC; secondary outcomes included survival to ICU and hospital discharge, neurologic outcomes, and arterial blood pressure (ABP).

Main Results:

• The AV uncompressed group showed a higher probability of sustained ROSC (53.8% vs. 24.3%) and any ROSC (56.4% vs. 32.4%) compared to the AV compressed group.
• Survival to ICU was significantly higher in the AV uncompressed group (33.3% vs. 8.1%).
• Higher initial diastolic ABP and a greater proportion achieving diastolic ABP > 20 mm Hg during CPR were observed in the AV uncompressed group.

Conclusions:

• Absence of AV compression during OHCA resuscitation is associated with increased chances of ROSC and ICU survival.
• Uncompressed AV appears critical for sustained ROSC across various subgroups.
• The long-term impact of avoiding AV compression on patient outcomes requires further investigation.