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(Circulation. 2005;112:IV-78 – IV-83.)
© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Part 7.4: Monitoring and Medications

	Introduction

 
This section provides an overview of monitoring techniques and medications that may be useful during CPR and in the immediate prearrest and postarrest settings.

	Monitoring Immediately Before, During, and After Arrest

 
Assessment During CPR
At present there are no reliable clinical criteria that clinicians can use to assess the efficacy of CPR. Although end-tidal CO₂ serves as an indicator of cardiac output produced by chest compressions and may indicate return of spontaneous circulation (ROSC),^1,2 there is little other technology available to provide real-time feedback on the effectiveness of CPR.

Assessment of Hemodynamics
Coronary Perfusion Pressure
Coronary perfusion pressure (CPP = aortic relaxation [diastolic] pressure minus right atrial relaxation phase blood pressure) during CPR correlates with both myocardial blood flow and ROSC (LOE 3).^3,4 A CPP of 15 mm Hg is predictive of ROSC. Increased CPP correlates with improved 24-hour survival rates in animal studies (LOE 6)⁵ and is associated with improved myocardial blood flow and ROSC in animal studies of epinephrine, vasopressin, and angiotensin II (LOE 6).^5–7

When intra-arterial monitoring is in place during the resuscitative effort (eg, in an intensive care setting), the clinician should try to maximize arterial diastolic pressures to achieve an optimal CPP. Assuming a right atrial diastolic pressure of 10 mm Hg means that the aortic diastolic pressure should ideally be at least 30 mm Hg to maintain a CPP of 20 mm Hg during CPR. Unfortunately such monitoring is rarely available outside the intensive care environment.

Pulses
Clinicians frequently try to palpate arterial pulses during chest compressions to assess the effectiveness of compressions. No studies have shown the validity or clinical . . . [Full Text of this Article]