Physiologically-Tailored Resuscitation

Currently, CPR interventions are delivered according to guidelines-driven protocols. These protocols lack flexibility to adapt to specific features of the victim and to changing physiologic conditions as the CPR effort progresses. Thus, CPR is delivered in a highly prescriptive manner without capability for tailoring interventions. We have shown at the Resuscitation Institute in a swine model of ventricular fibrillation (VF), that delivering electrical shocks according to the probability of shock success based on real-time analysis of the VF amplitude spectral area (AMSA) is superior to a guidelines-driven protocol. With the AMSA-driven protocol, the burden of unsuccessful shocks is reduced leading to better post-resuscitation myocardial function and improved short-term survival.¹   We have recently expanded our AMSA-driven protocol to also limit the administration of epinephrine to only when increasing myocardial perfusion is required for successful defibrillation and thereby reducing myocardial adrenergic burden and the consequent adverse post-resuscitation effects.²