Abstract 247: Cardiac Arrest Management in Rural Prehospital Care

Introduction: Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. We analyzed a nationwide database of emergency medical services (EMS) incidents in the US to describe treatment patterns and the odds of return of spontaneous circulation (ROSC) among rural OHCA patients. Methods: Using the 2018 National EMS Informational System dataset, we analyzed OHCA incidents where CPR provided by EMS was documented. We excluded incidents in which trauma was involved, patient age <18 years, transport was not by completed by an advanced life support unit, or response time >60 minutes. The primary outcome was ROSC during the EMS incident. Multivariable logistic regression was performed comparing rural, suburban, and urban settings while controlling for age and gender, incident location type, response time, CPR prior to EMS arrival, arrest witnessed by EMS, initial rhythm, epinephrine administration, mechanical CPR, and advanced airway used. Results: A total of 60,281 OHCA incidents were identified for inclusion, including 5,013 (8.6%) in rural settings. Rural OHCA patients achieved ROSC in 28.8% of cases, compared to 33.0% in urban or suburban settings (p<0.001). Neither age nor gender significantly differed between settings (Table 1). Rural OHCA incidents had greater response times (7.5 vs. 5.9 minutes, p<0.001) and were less likely to receive epinephrine (71.6% vs. 74.9%, p<0.001). Further, EMS were more likely to use mechanical CPR (29.8% vs. 28.1%, p=0.01) and less likely to provide an advanced airway (56.3% vs. 50.5%, p<0.001) for rural OHCA. On multivariable logistic regression, rural OHCA patients had lower odds of achieving ROSC than urban OHCA patients after controlling for other factors (0.80, 95%CI: 0.75-0.86). Conclusion: In this national sample of EMS-treated OHCA, rural patients were less likely to achieve ROSC than patients in urban or suburban settings.

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Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽

10.1161/circ.138.suppl_2.150 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Gunnar W Skjeflo ◽

Eirik Skogvoll ◽

Jan Pål Loennechen ◽

Theresa M Olasveengen ◽

Lars Wik ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Arrest ◽

Electrical Activity ◽

Multivariate Regression ◽

Life Support ◽

Controlled Trial ◽

Pulseless Electrical Activity ◽

Qrs Complex ◽

Epinephrine Administration ◽

Hospital Cardiac Arrest

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

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Abstract 138: A Before and After Study of Active Compression Decompression Cardiopulmonary Resuscitation With the Impedance Threshold Device in a Large Urban Pre-Hospital System

Circulation ◽

10.1161/circ.138.suppl_2.138 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Johanna C Moore ◽

Michael Grahl ◽

Tracy Marko ◽

Ariel Blythe-Reske ◽

Amber Lage ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Response Time ◽

First Responders ◽

The United States ◽

Threshold Device ◽

Before And After ◽

Mechanical Cpr ◽

Impedance Threshold Device ◽

Before And After Study

Introduction: Active Compression Decompression cardiopulmonary resuscitation with an impedance threshold device (ACD+ITD CPR) is available for use in the United States. However, little is known regarding integration of this CPR system into a large urban prehospital system with short response times, routine use of mechanical CPR and ITD, and transport of patients to cardiac arrest centers. This is an ongoing before and after study of the implementation of ACD+ITD CPR in non-traumatic cardiac arrest cases 6 months pre and post protocol change. Hypothesis: Neurologically intact rates of survival, defined by Cerebral Performance Category (CPC) score of 1 or 2, would be higher post protocol. Methods: Basic life support first responders (n = 420) and paramedics (n = 207) underwent training including didactic and hands-on sessions to learn ACD+ITD CPR. The protocol included ACD+ITD CPR initially, with the option to transition to mechanical CPR at 15 minutes. Demographics, response time, CPR duration, initial rhythm, signs of perfusion during CPR, and return of spontaneous circulation (ROSC) were recorded prospectively by first responders. Chart review was performed to determine survival to hospital admission and CPC score at discharge. Results: Training occurred October 2016 to March 2017, with protocol change on May 1, 2017. Cases from November 2016-April 2017 (n = 136) and May 2017-November 2017 (n= 103) were reviewed. Complete data were available for 128 subjects pre-protocol change (94%) and 96 subjects (94%) post. Age, gender, response time, rhythm, total CPR time, and rates of bystander CPR and witnessed arrest were similar between groups. Post protocol change, 87% (89/102) received ACD+ITD CPR with median ACD+ITD CPR time of 15 minutes (range 2-300). Pre-protocol, 6/128 (4.7%) subjects survived with CPC score 1 or 2, versus 8/96 (13.5%) subjects post (difference 8.8%, 95% CI 1%-17%). ROSC rates were similar (pre: 54/127, 42.5% post: 44/93, 47%, difference 4.8%, 95% CI -8% - 18%) Conclusions: The change in protocol was straightforward with a high rate of adherence of the system for the recommended duration of therapy. Results are suggestive of a higher rate of neurological survival with the routine use of ACD+ITD CPR in a small cardiac arrest patient population.

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Abstract TP245: Variance in Ems Run Times by Receiving Hospital for Stroke Patients in San Diego County

Stroke ◽

10.1161/str.51.suppl_1.tp245 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amelia Kenner-brininger ◽

Lindsay Olson-Mack ◽

Lorraine Calzone ◽

Kristi L Koenig ◽

Thomas M Hemmen

Keyword(s):

Response Time ◽

San Diego ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

San Diego County ◽

Stroke Patients ◽

Transport Time ◽

Stroke Registry ◽

Few Data

Background: Emergency Medical Services (EMS) play an important role as initial providers after stroke. Few data are available that capture Stroke Receiving System and EMS response and transport data. We used a stroke registry from a community of 3.3 million residents, 18 stroke receiving centers, and 19 ground transporting advanced life support EMS agencies to evaluate EMS response time, scene time, and transport times. Our aim was to inform the stroke community about duration of EMS care and guide future prehospital interventions. Methods: We included all cases from the San Diego County Stroke Registry arriving by EMS with associated computer automated dispatch (CAD) record and base hospital record (BHR) from July 2017 through December 2018. Records were linked on the EMS incident number, reviewed for accuracy. We analyzed EMS response, scene, transport and total run times (enroute to arrival) by receiving hospital. Results: Between July 2017 and December 2018 2,376 EMS patients were transported to 18 hospitals. Volume per hospital ranged from 11 to 483 patients over the study period. Mean (±SD) response time was 7.0 (±3.7) minutes, range: 5.3 to 9.3 minutes between hospitals. Mean (±SD) scene time was 13.1 (±5.2) minutes, range: 10.5 to 15.0 minutes between hospitals. Transport time averaged 13.8 (±7.7) minutes, range: 8.3 to 23.8 minutes between hospitals (IQR=8.5-17.9). The mean (±SD) total EMS run time was 33.8 (±10.8) minutes, range: 26.4 to 44.9 minutes between hospitals (IQR=26.4-39.9). Conclusion: Only minor variations in EMS response and scene times were observed across the Stroke Receiving Centers. However, transport time showed greater variation and contributed to the differences in total EMS run times. Many systems had short transport times, limiting prehospital interventions. Next steps include studying factors contributing to transport time variation to inform prehospital care and triage decisions of possible stroke patients to optimize transport times.

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Abstract 9086: Sex Differences in the Association Between Bystander CPR and Survival for Patients With Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.9086 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Kiok Ahn ◽

Bryan McNally ◽

Paul Chan

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Significant Interaction ◽

National Registry ◽

Republic Of Korea ◽

Secondary Outcome ◽

Multivariable Logistic Regression ◽

Bystander Cpr ◽

The Republic ◽

Hospital Cardiac Arrest

Background: Bystander cardiopulmonary resuscitation (CPR) is associated with a better survival outcome in patients with out-of-hospital cardiac arrest (OHCA). However, there may be cultural barriers in performing high-quality bystander CPR in women in some non-Western countries and the effect of bystander CPR on survival outcomes may differ by patients’ sex. Methods: Using data between 2012-2018 from a national OHCA registry from the Republic of Korea, we identified adult patients with OHCA of presumed cardiac etiology. The main exposures were bystander CPR and patients’ sex. The primary outcome was survival discharge and the secondary outcome was favorable neurological survival. Multivariable logistic regression evaluated the association between bystander CPR and survival, adjusted for patients’ age, sex, socio-economic status, year of arrest, witnessed arrest status, initial OHCA rhythm, location of arrest, urbanization level of arrest location, and type of bystander. The interaction between bystander CPR and sex was explicitly evaluated in the models. Results: Of 101,505 patients with OHCA in the cohort, 34,124 (33.6 %) were women and 67,381 (64.4 %) were men. Bystander CPR was performed on 18,481 (54.2%) women and 35,904 (53.3%) men (p=0.07). Unadjusted rates of survival discharge were 4.5% in women and 9.5 % in men (p<0.001), and rates of favorable neurological survival were 2.5% in women and 6.4% in men (p<0.001). In multivariable logistic regression models, there was a significant interaction (p=0.005) between bystander CPR and sex for survival to discharge, with an adjusted OR for bystander CPR of 1.16 (95% CI: 1.08-1.23) in men and 0.91 (95% CI: 0.80-1.02) in women. For favorable neurological survival, there was also a significant interaction (p=0.01) between sex and bystander CPR, with an adjusted OR for bystander CPR of 1.47 (95% CI: 1.36-1.60) in men and 1.16 (95% CI: 0.98- 1.37) in women. Conclusions: In a national registry of OHCA from the Republic of Korea, men who received bystander CPR were more likely to survive whereas women who received bystander CPR were not.

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Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury

Emergency Medicine Journal ◽

10.1136/emermed-2021-211723 ◽

2021 ◽

pp. emermed-2021-211723

Author(s):

Tan N Doan ◽

Daniel Wilson ◽

Stephen Rashford ◽

Louise Sims ◽

Emma Bosley

Keyword(s):

Cardiac Arrest ◽

Motor Vehicle ◽

Burn Injury ◽

Prehospital Care ◽

Survival Rates ◽

Traumatic Cardiac Arrest ◽

Vehicle Collision ◽

Advanced Airway ◽

Injury Mechanisms ◽

High Acuity

BackgroundSurvival from out-of-hospital traumatic cardiac arrest (TCA) is poor. Regional variation exists regarding epidemiology, management and outcomes. Data on prognostic factors are scant. A better understanding of injury patterns and outcome determinants is key to identifying opportunities for survival improvement.MethodsIncluded were adult (≥18 years) out-of-hospital TCA due to blunt, penetrating or burn injury, who were attended by Queensland Ambulance Service paramedics between 1 January 2007 and 31 December 2019. We compared the characteristics of patients who were pronounced dead on paramedic arrival and those receiving resuscitation from paramedics. Intra-arrest procedures were described for attempted-resuscitation patients. Survival up to 6 months postarrest was reported, and factors associated with survival were investigated.Results3891 patients were included; 2394 (61.5%) were pronounced dead on paramedic arrival and 1497 (38.5%) received resuscitation from paramedics. Most arrests (79.8%) resulted from blunt trauma. Motor vehicle collision (42.4%) and gunshot wound (17.7%) were the most common injury mechanisms in patients pronounced dead on paramedic arrival, whereas the most prevalent mechanisms in attempted-resuscitation patients were motor vehicle (31.3%) and motorcycle (20.6%) collisions. Among attempted-resuscitation patients, rates of transport and survival to hospital handover, to hospital discharge and to 6 months were 31.9%, 15.3%, 9.8% and 9.8%, respectively. Multivariable model showed that advanced airway management (adjusted OR 1.84; 95% CI 1.06 to 3.17), intravenous access (OR 5.04; 95% CI 2.43 to 10.45) and attendance of high acuity response unit (highly trained prehospital care clinicians) (OR 2.54; 95% CI 1.25 to 5.18) were associated with improved odds of survival to hospital handover.ConclusionsBy including all paramedic-attended patients, this study provides a more complete understanding of the epidemiology of out-of-hospital TCA. Contemporary survival rates from adult out-of-hospital TCA who receive resuscitation from paramedics may be higher than historically thought. Factors identified in this study as associated with survival may be useful to guide prognostication and treatment.

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Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system

CJEM ◽

10.1017/s1481803500005522 ◽

2001 ◽

Vol 3 (03) ◽

pp. 186-192 ◽

Cited By ~ 16

Author(s):

David A. Petrie ◽

Valerie De Maio ◽

Ian G. Stiell ◽

Jonathan Dreyer ◽

Michael Martin ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Basic Life Support ◽

Life Support ◽

Ethical Decision Making ◽

Pulseless Electrical Activity ◽

Advanced Life Support ◽

Stepwise Logistic Regression ◽

Bystander Cpr

ABSTRACT Objectives: Previous studies have shown a low but meaningful survival rate in cases of prehospital cardiac arrest with an initial rhythm of asystole. There may be, however, an identifiable subgroup in which resuscitation efforts are futile. This study identified potential field criteria for predicting 100% nonsurvival when the presenting rhythm is asystole in a Basic Life Support-Defibrillation (BLS-D) system. Methods: This prospective cohort study, a component of Phases I and II of the Ontario Prehospital Advanced Life Support (OPALS) Study, was conducted in 21 Ontario communities with BLS-D level of care, and included all adult arrests of presumed cardiac etiology according to the Utstein Style Guidelines. Analyses included descriptive and appropriate univariate tests, as well as multivariate stepwise logistic regression to determine predictors of survival. Results: From 1991 to 1997, 9899 consecutive cardiac arrest cases with the following characteristics: male (67.2%), bystander-witnessed (44.7%), bystander CPR (14.2%), call–response interval (CRI) ≤ 8 minutes (82%) and overall survival (4.3%) were enrolled. Of 9529 cases with available rhythm strip recordings, initial arrest rhythms were asystole in 40.8%, pulseless electrical activity in 21.2% and ventricular fibrillation or ventricular tachycardia in 38%. Of 3888 asystolic patients, 9 (0.2%) survived to discharge; 3 of these cases were unwitnessed arrests with no bystander CPR. There were no survivors if the CRI exceeded 8 minutes. Logistic regression analysis demonstrated that independent predictors of survival to admission were “CRI in minutes” (odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and “bystander-witnessed” (OR = 2.6; 95% CI, 1.5–4.4). Conclusions: In a BLS-D system, there is a very low but measurable survival rate for prehospital asystolic cardiac arrest. CRIs of over 8 minutes were associated with 100% nonsurvival, whereas unwitnessed arrests with no bystander CPR were not. These data add to the growing literature that will help guide ethical decision-making for protocol development in emergency medical services systems.

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The influence of advanced life support response time on patient outcomes after out-of-hospital cardiac arrest in Taipei

Resuscitation ◽

10.1016/j.resuscitation.2019.06.244 ◽

2019 ◽

Vol 142 ◽

pp. e101

Author(s):

Ying-Chih Ko ◽

Jen-Tang Sun ◽

Wen-Chu Chiang ◽

Yu-Chun Chien ◽

Yao-Cheng Wang ◽

...

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Patient Outcomes ◽

Life Support ◽

Advanced Life Support ◽

Hospital Cardiac Arrest

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Accidental Hypothermia: 2021 Update

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010501 ◽

2022 ◽

Vol 19 (1) ◽

pp. 501

Author(s):

Peter Paal ◽

Mathieu Pasquier ◽

Tomasz Darocha ◽

Raimund Lechner ◽

Sylweriusz Kosinski ◽

...

Keyword(s):

Cardiac Arrest ◽

Core Temperature ◽

Life Support ◽

Extracorporeal Life Support ◽

Clinical Signs ◽

Accidental Hypothermia ◽

Care Bundle ◽

Elderly Persons ◽

Ventricular Dysrhythmias ◽

Mechanical Cpr

Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

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Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Circulation ◽

10.1161/circ.138.suppl_2.351 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Katsutaka Hashiba ◽

Yoshio Tahara ◽

Kazuo Kimura ◽

Tsutomu Endo ◽

Kouichi Tamura ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Airway Management ◽

Neurological Outcome ◽

Medical Service ◽

Life Support ◽

Advanced Life Support ◽

Advanced Airway ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p<0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p<0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p<0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p<0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p<0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

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Abstract 249: Association of Diastolic Blood Pressure and Myocardial Perfusion Pressure with Survival During Pediatric Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.249 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Jill L Sorcher ◽

Donald H Shaffner ◽

Caitlin OBrien

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Myocardial Perfusion ◽

Diastolic Blood Pressure ◽

Chest Compression ◽

Life Support ◽

Perfusion Pressure ◽

Diastolic Pressure ◽

Secondary Analysis ◽

Epinephrine Administration

Introduction: Myocardial perfusion pressure (MPP), defined as the aortic diastolic pressure minus the central venous diastolic pressure, is an important determinant of return of spontaneous circulation (ROSC) in cardiac arrest. However, measuring MPP requires both arterial and venous catheters and is often not possible. When only invasive arterial monitoring is available, diastolic blood pressure (DBP) is suggested as a surrogate for MPP during resuscitation and is also associated with survival after cardiac arrest. Hypothesis: We hypothesized that DBP measured during chest compression delivery would mirror MPP during resuscitation and both would be associated with survival. Methods: We performed a retrospective, secondary analysis of 102 swine resuscitations. Pediatric swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS). MPP and DBP were recorded every 30 s during chest compression delivery. Results: For both survivors and non-survivors, DBP mirrored MPP throughout resuscitation ( Figure 1A, B ). During BLS, both MPP and DBP were significantly greater in survivors (MPP: 8.5 0.6 vs. 1.1 0.5 mmHg; p < 0.0001; DBP 17.3 0.6 vs. 8.7 0.5 mmHg; p < 0.0001). During ALS, MPP and DBP were greater in survivors than non-survivors (MPP: 20.5 1.0 vs. 0.7 0.3 mmHg; p < 0.0001; DBP 32.3 0.9 vs. 8.8 0.2 mmHg; p < 0.0001). During ALS, the magnitude of change in both MPP and DBP after the first epinephrine administration in survivors was greater than in non-survivors (MPP: 24.4 3.3 vs. 4.8 0.9 mmHg; p < 0.0001; DBP: 24.5 3.1 vs. 5.4 0.8 mmHg; p < 0.0001). Conclusion: These observations confirm that both DBP and MPP are associated with survival in cardiac arrest and validate the use of DBP as a surrogate for MPP. Figure 1: Myocardial perfusion pressure (MPP) and diastolic blood pressure (DBP) during BLS and ALS in survivors (A) and non-survivors (B). Arrows indicate administration of epinephrine during ALS.

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