Clinical assessment of patients undergoing CPR in the emergency department

A problem frequently encountered in the emergency department is assessing the effectiveness of cardiopulmonary resuscitation (CPR), particularly when it is continued over a period of time. To evaluate the effectiveness of CPR in our emergency department we use a mechanical cardiopulmonary resuscitator (Michigan Instruments, Thumper) together with early invasive monitoring of pulse and blood pressure. This also allows for frequent monitoring of blood gases. Three patients are presented who underwent longterm CPR (ie, longer than one hour), and invasive monitoring. Results indicate that better management of the clinical status of patients undergoing prolonged resuscitation can be obtained by using continuous blood pressure and pulse monitoring, and frequent blood gas analysis. In addition, when frequent arrhythmias are taking place, this system allows for better determination of appropriate procedures and medications.