Coupled cardio-pulmonary-cerebral functional dynamics for high-quality cardiopulmonary resuscitation

Cardiac arrest (CA) is one of the leading causes of death worldwide. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of CA patients. To find physiological indicators particularly those reflecting the cerebral function to assess the quality of CPR is a challenging issue. This study aimed to investigate the cardio-pulmonary-cerebral coupling to assess the physiological status of CA patients during CPR.

Arterial blood pressure (ABP), electroencephalography (EEG), and end-tidal carbon dioxide partial pressure (PETCO₂) signals collected in porcine experiments were divided into four periods: Baseline, CA, CPR, and recovery of spontaneous circulation (ROSC). Cross recurrence quantification analysis (CRQA) was applied to examine the dynamical couplings of ABP-EEG, ABP-PETCO₂, and EEG-PETCO₂ during the four periods. In addition, a joint recurrence quantification analysis (JRQA) was applied to examine the cardio-pulmonary-cerebral dynamical coupling across the ABP, EEG, and PETCO₂ during the four periods.

The RR, DET, ENTR, and L_max of ABP-PETCO₂ coupling using CRQA were significantly lower during CA than during Baseline, and these parameters were significantly higher during CPR and ROSC than during CA. The RR and DET of ABP-EEG and PETCO₂-EEG coupling were highest during CPR and lowest during CA (p < 0.05), and they were higher in the T7 cortical region during Baseline than other regions (p < 0.05). The RR, DET, and ENTR of ABP-PETCO₂-EEG coupling using JRQA showed significantly higher values during CA than during the other periods, and the L_max of ABP-PETCO₂-EEG coupling exhibited significantly lower values during CA than during the other periods.

Dynamical coupling of ABP-PETCO₂-EEG could reflect the physiological states of CA patients. The T7 cortical region was identified as the most sensitive to the CPR process. This study sheds light on the value of cardio-pulmonary-cerebral dynamical coupling in indication of the effects of CPR and may play a role in screening the function of vital organs during emergency treatment.