{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:39:51Z","timestamp":1780468791931,"version":"3.54.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2014,12,1]],"date-time":"2014-12-01T00:00:00Z","timestamp":1417392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Although current resuscitation guidelines are rescuer focused, the opportunity exists to develop patient-centered resuscitation strategies that optimize the hemodynamic response of the individual in the hopes to improve survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if titrating cardiopulmonary resuscitation (CPR) to blood pressure would improve 24-hour survival compared with traditional CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine randomly received either blood pressure\u2013targeted care consisting of titration of compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American Heart Association Guideline care consisting of depth of 51 mm with standard advanced cardiac life support epinephrine dosing (Guideline care). All animals received manual CPR for 10 minutes before first shock. Primary outcome was 24-hour survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The 24-hour survival was higher in the BP care group (8 of 10) compared with Guideline care (0 of 10); P\u2009=\u20090.001. Coronary perfusion pressure was higher in the BP care group (point estimate +8.5 mm Hg; 95% confidence interval, 3.9\u201313.0 mm Hg; P\u2009&amp;lt;\u20090.01); however, depth was higher in Guideline care (point estimate +9.3 mm; 95% confidence interval, 6.0\u201312.5 mm; P\u2009&amp;lt;\u20090.01). Number of vasopressor doses before first shock was higher in the BP care group versus Guideline care (median, 3 [range, 0\u20133] vs. 2 [range, 2\u20132]; P\u2009=\u20090.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Blood pressure\u2013targeted CPR improves 24-hour survival compared with optimal American Heart Association care in a porcine model of asphyxia-associated VF cardiac arrest.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201407-1343oc","type":"journal-article","created":{"date-parts":[[2014,10,16]],"date-time":"2014-10-16T11:02:02Z","timestamp":1413457322000},"page":"1255-1262","source":"Crossref","is-referenced-by-count":98,"title":["Patient-Centric Blood Pressure\u2013targeted Cardiopulmonary Resuscitation Improves Survival from Cardiac Arrest"],"prefix":"10.1093","volume":"190","author":[{"given":"Robert M.","family":"Sutton","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart H.","family":"Friess","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St. Louis Children\u2019s Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Y.","family":"Naim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua W.","family":"Lampe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bratinov","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Theodore R.","family":"Weiland","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Garuccio","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay M.","family":"Nadkarni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance B.","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,12,1]]},"reference":[{"issue":"18","key":"2026032100283161800_bib1","first-page":"S729","article-title":"Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"122","author":"Neumar","year":"2010","journal-title":"Circulation"},{"issue":"18","key":"2026032100283161800_bib2","first-page":"S876","article-title":"Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"122","author":"Kleinman","year":"2010","journal-title":"Circulation"},{"key":"2026032100283161800_bib3","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.resuscitation.2014.04.015","article-title":"Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest","volume":"85","author":"Sutton","year":"2014","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib4","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.1097\/CCM.0b013e3182257459","article-title":"Incidence of treated cardiac arrest in hospitalized patients in the United States","volume":"39","author":"Merchant","year":"2011","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib5","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1097\/CCM.0b013e31828cf0c0","article-title":"Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing","volume":"41","author":"Berg","year":"2013","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib6","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1056\/NEJMoa1109148","article-title":"Trends in survival after in-hospital cardiac arrest","volume":"367","author":"Girotra","year":"2012","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib7","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/0300-9572(88)90111-6","article-title":"Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs","volume":"16","author":"Kern","year":"1988","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib8","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0196-0644(84)80566-1","article-title":"Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: improved regional blood flow and resuscitation in dogs","volume":"13","author":"Ralston","year":"1984","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.ajem.2009.10.006","article-title":"Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest","volume":"28","author":"Halperin","year":"2010","journal-title":"Am J Emerg Med"},{"key":"2026032100283161800_bib10","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1097\/00003246-198410000-00007","article-title":"Prognostic and therapeutic importance of the aortic diastolic pressure in resuscitation from cardiac arrest","volume":"12","author":"Sanders","year":"1984","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib11","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1161\/CIR.0b013e31829d8654","article-title":"Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association","volume":"128","author":"Meaney","year":"2013","journal-title":"Circulation"},{"key":"2026032100283161800_bib12","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1097\/CCM.0b013e318298ad6b","article-title":"Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest","volume":"41","author":"Friess","year":"2013","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib13","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.resuscitation.2012.10.023","article-title":"Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest","volume":"84","author":"Sutton","year":"2013","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib14","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.resuscitation.2008.12.014","article-title":"Comparison of mechanical characteristics of the human and porcine chest during cardiopulmonary resuscitation","volume":"80","author":"Neurauter","year":"2009","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib15","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1097\/00003246-199909000-00030","article-title":"Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest","volume":"27","author":"Berg","year":"1999","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib16","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1161\/01.CIR.101.14.1743","article-title":"\u201cBystander\u201d chest compressions and assisted ventilation independently improve outcome from piglet asphyxial pulseless \u201ccardiac arrest\u201d","volume":"101","author":"Berg","year":"2000","journal-title":"Circulation"},{"key":"2026032100283161800_bib17","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/CCM.0b013e3181b43282","article-title":"Rhythms and outcomes of adult in-hospital cardiac arrest","volume":"38","author":"Meaney","year":"2010","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib18","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/S0140-6736(12)60862-9","article-title":"Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study","volume":"380","author":"Goldberger","year":"2012","journal-title":"Lancet"},{"key":"2026032100283161800_bib19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.resuscitation.2003.12.021","article-title":"Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation","volume":"61","author":"Berg","year":"2004","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib20","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1161\/hc4501.098926","article-title":"Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest","volume":"104","author":"Berg","year":"2001","journal-title":"Circulation"},{"key":"2026032100283161800_bib21","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data analysis using generalized linear models","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"key":"2026032100283161800_bib22","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1056\/NEJMoa052917","article-title":"Outcomes of in-hospital ventricular fibrillation in children","volume":"354","author":"Samson","year":"2006","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib23","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1056\/NEJMoa0706467","article-title":"Delayed time to defibrillation after in-hospital cardiac arrest","volume":"358","author":"Chan","year":"2008","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib24","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.295.1.50","article-title":"First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults","volume":"295","author":"Nadkarni","year":"2006","journal-title":"JAMA"},{"key":"2026032100283161800_bib25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1001\/archinternmed.2009.424","article-title":"Rapid response teams: a systematic review and meta-analysis","volume":"170","author":"Chan","year":"2010","journal-title":"Arch Intern Med"},{"key":"2026032100283161800_bib26","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1001\/jama.2008.715","article-title":"Hospital-wide code rates and mortality before and after implementation of a rapid response team","volume":"300","author":"Chan","year":"2008","journal-title":"JAMA"},{"key":"2026032100283161800_bib27","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1001\/jama.1990.03440080084029","article-title":"Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation","volume":"263","author":"Paradis","year":"1990","journal-title":"JAMA"},{"key":"2026032100283161800_bib28","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/0002-8703(90)90076-A","article-title":"The effect of coronary artery lesions on the relationship between coronary perfusion pressure and myocardial blood flow during cardiopulmonary resuscitation in pigs","volume":"120","author":"Kern","year":"1990","journal-title":"Am Heart J"},{"key":"2026032100283161800_bib29","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S0196-0644(85)80774-5","article-title":"Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation","volume":"14","author":"Niemann","year":"1985","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib30","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/S0196-0644(82)80236-9","article-title":"Coronary perfusion pressure during experimental cardiopulmonary resuscitation","volume":"11","author":"Niemann","year":"1982","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib31","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S0735-1097(85)80261-8","article-title":"Importance of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest","volume":"6","author":"Sanders","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2026032100283161800_bib32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.3109\/10903120903349796","article-title":"Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest","volume":"14","author":"Reynolds","year":"2010","journal-title":"Prehosp Emerg Care"},{"key":"2026032100283161800_bib33","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1084\/jem.8.6.713","article-title":"An experimental research into the resuscitation of dogs killed by anesthetics and asphyxia","volume":"8","author":"Crile","year":"1906","journal-title":"J Exp Med"},{"key":"2026032100283161800_bib34","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1097\/CCM.0b013e31823bc8bb","article-title":"What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?","volume":"40","author":"Stiell","year":"2012","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib35","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.resuscitation.2014.05.007","article-title":"2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival","volume":"85","author":"Sutton","year":"2014","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib36","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.resuscitation.2006.04.008","article-title":"Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest","volume":"71","author":"Edelson","year":"2006","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib37","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.resuscitation.2006.05.011","article-title":"Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study","volume":"71","author":"Kramer-Johansen","year":"2006","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib38","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.resuscitation.2014.01.028","article-title":"A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries","volume":"85","author":"Miller","year":"2014","journal-title":"Resuscitation"},{"key":"2026032100283161800_bib39","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/00003246-199205000-00011","article-title":"Plasma catecholamine concentrations after successful resuscitation in patients","volume":"20","author":"Prengel","year":"1992","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib40","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1378\/chest.106.5.1499","article-title":"The effect of the total cumulative epinephrine dose administered during human CPR on hemodynamic, oxygen transport, and utilization variables in the postresuscitation period","volume":"106","author":"Rivers","year":"1994","journal-title":"Chest"},{"key":"2026032100283161800_bib41","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJM199210083271502","article-title":"High-dose epinephrine in adult cardiac arrest","volume":"327","author":"Stiell","year":"1992","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib42","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1056\/NEJMoa032440","article-title":"A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest","volume":"350","author":"Perondi","year":"2004","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib43","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1001\/jama.2009.1729","article-title":"Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial","volume":"302","author":"Olasveengen","year":"2009","journal-title":"JAMA"},{"key":"2026032100283161800_bib44","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1097\/00003246-198511000-00011","article-title":"Cardiac output and end-tidal carbon dioxide","volume":"13","author":"Weil","year":"1985","journal-title":"Crit Care Med"},{"key":"2026032100283161800_bib45","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1161\/01.CIR.77.1.234","article-title":"Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation","volume":"77","author":"Gudipati","year":"1988","journal-title":"Circulation"},{"key":"2026032100283161800_bib46","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/S0196-0644(85)80235-3","article-title":"Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest","volume":"14","author":"Sanders","year":"1985","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib47","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/S0196-0644(05)81512-4","article-title":"Relationship between cardiac output and the end-tidal carbon dioxide tension","volume":"19","author":"Ornato","year":"1990","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib48","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/S0196-0644(89)80005-8","article-title":"The effect of applied chest compression force on systemic arterial pressure and end-tidal carbon dioxide concentration during CPR in human beings","volume":"18","author":"Ornato","year":"1989","journal-title":"Ann Emerg Med"},{"key":"2026032100283161800_bib49","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1056\/NEJM199707313370503","article-title":"End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest","volume":"337","author":"Levine","year":"1997","journal-title":"N Engl J Med"},{"key":"2026032100283161800_bib50","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/S0140-6736(01)05328-4","article-title":"Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial","volume":"358","author":"Stiell","year":"2001","journal-title":"Lancet"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/190\/11\/1255\/67218801\/ajrccm_190_11_1255.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/190\/11\/1255\/67218801\/ajrccm_190_11_1255.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:28:46Z","timestamp":1774067326000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/190\/11\/1255\/8505372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,1]]},"references-count":50,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2014,12,1]]},"published-print":{"date-parts":[[2014,12,1]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201407-1343oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2014,12]]},"published":{"date-parts":[[2014,12,1]]}}}