{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:17:15Z","timestamp":1788171435195,"version":"build-2803163510"},"reference-count":29,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Physiology-guided cardiopulmonary resuscitation (CPR) is increasingly recognized as a strategy to move beyond mechanical targets, but evidence remains limited and dominated by isolated metrics. We characterized multimodal physiologic profiles associated with return of spontaneous circulation (ROSC) in a swine model. Methods: We analyzed 24 swine undergoing standardized cardiac arrest followed by CPR. Variables included end-tidal carbon dioxide (ETCO2), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), right ventricular systolic pressure (RVSP), carotid artery blood flow, stroke volume, and cerebral regional oxygen saturation. The primary early analysis used per-animal medians from minutes 1\u20135 of CPR, before any animal achieved ROSC. Later prespecified 5 min windows were evaluated exploratorily because they increasingly included post-ROSC measurements. A pre-ROSC sensitivity analysis, correlation analysis, and exploratory principal component analysis (PCA) with bootstrap assessment of loading stability were also performed. Results: Nine animals (37.5%) achieved ROSC, with a median time to ROSC of 10 min (range 6\u201318 min). During minutes 1\u20135, before any ROSC occurred, animals subsequently achieving ROSC had higher carotid flow, DAP, ETCO2, right ventricular pressure signal, and SAP; all differences remained significant after false discovery rate correction. In the pre-ROSC sensitivity analysis, ETCO2, SAP, DAP, right ventricular pressure signal, carotid flow, and stroke volume differed between animals subsequently achieving ROSC and those that did not (all p &lt; 0.001), whereas cerebral regional oxygen saturation did not (p = 0.474). Later analytical windows increasingly included post-ROSC measurements and were therefore interpreted exploratorily. PCA summarized the shared early physiologic variation, with PC1 explaining 69.8% of variance; bootstrap analysis showed consistent positive contributions of the included variables to PC1. Conclusions: Successful resuscitation was associated with a distinct pressure\u2013flow\u2013gas-exchange profile during early and pre-ROSC CPR. These findings support further investigation of multimodal physiology-guided resuscitation.<\/jats:p>","DOI":"10.3390\/jcm15176682","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"6682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal Physiologic Profiles Associated with Return of Spontaneous Circulation in a Swine Model of Cardiopulmonary Resuscitation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-0134","authenticated-orcid":false,"given":"Barbara","family":"Fyntanidou","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Eirini","family":"Oloktsidou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0241-7216","authenticated-orcid":false,"given":"Katerina","family":"Kotzampassi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9409-388X","authenticated-orcid":false,"given":"Marios G.","family":"Bantidos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece"},{"name":"Second Department of Cardiology, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Christos","family":"Kofos","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-8121","authenticated-orcid":false,"given":"Andreas S.","family":"Papazoglou","sequence":"additional","affiliation":[{"name":"Athens Naval Hospital, Deinokratous 70, 11521 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6678-2824","authenticated-orcid":false,"given":"Georgios","family":"Kazakos","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Stavrou Voutyra 11, 54627 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-3478","authenticated-orcid":false,"given":"Aikaterini","family":"Apostolopoulou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3057-5297","authenticated-orcid":false,"given":"Athina","family":"Nasoufidou","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-7280","authenticated-orcid":false,"given":"Alexandra","family":"Arvanitaki","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Maria","family":"Fasoula","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, AHEPA University General Hospital, School of Medicine, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54636 Thessaloniki, 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Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.resuscitation.2021.02.010","article-title":"European Resuscitation Council Guidelines 2021: Adult Advanced Life Support","volume":"161","author":"Soar","year":"2021","journal-title":"Resuscitation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.resuscitation.2016.06.018","article-title":"Physiologic Monitoring of CPR Quality during Adult Cardiac Arrest: A Propensity-Matched Cohort Study","volume":"106","author":"Sutton","year":"2016","journal-title":"Resuscitation"},{"key":"ref_4","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":"ref_5","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":"ref_6","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":"Prehospital Emerg. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e000450","DOI":"10.1161\/JAHA.113.000450","article-title":"Efficacy of Chest Compressions Directed by End-Tidal CO2 Feedback in a Pediatric Resuscitation Model of Basic Life Support","volume":"3","author":"Hamrick","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1097\/CCM.0b013e318298ad6b","article-title":"Hemodynamic Directed CPR Improves Short-Term Survival from Ventricular Fibrillation Cardiac Arrest","volume":"41","author":"Friess","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100109","DOI":"10.1016\/j.resplu.2021.100109","article-title":"Focused Echocardiography, End-Tidal Carbon Dioxide, Arterial Blood Pressure or near-Infrared Spectroscopy Monitoring during Paediatric Cardiopulmonary Resuscitation: A Scoping Review","volume":"6","author":"Kool","year":"2021","journal-title":"Resusc. Plus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110092","DOI":"10.1016\/j.resuscitation.2023.110092","article-title":"A New Method to Evaluate Carotid Blood Flow by Continuous Doppler Monitoring during Cardiopulmonary Resuscitation in a Porcine Model of Cardiac Arrest","volume":"195","author":"Zhao","year":"2024","journal-title":"Resuscitation"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Percie du Sert, N., Hurst, V., Ahluwalia, A., Alam, S., Avey, M.T., Baker, M., Browne, W.J., Clark, A., Cuthill, I.C., and Dirnagl, U. (2020). The ARRIVE Guidelines 2.0: Updated Guidelines for Reporting Animal Research. PLoS Biol., 18.","DOI":"10.1371\/journal.pbio.3000410"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/CP9.0000000000000087","article-title":"Systematic Review of Swine Models for Ventricular Fibrillation Induction in Evaluating Cardiopulmonary Resuscitation Methods","volume":"9","author":"Low","year":"2024","journal-title":"Cardiol. Plus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.resuscitation.2004.09.011","article-title":"The Three-Phase Model of Cardiac Arrest as Applied to Ventricular Fibrillation in a Large, Urban Emergency Medical Services System","volume":"64","author":"Vilke","year":"2005","journal-title":"Resuscitation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1213\/ANE.0000000000000926","article-title":"The Physiology of Cardiopulmonary Resuscitation","volume":"122","author":"Lurie","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0735-6757(85)90003-8","article-title":"Coronary Perfusion Pressure during Cardiopulmonary Resuscitation","volume":"3","author":"Sanders","year":"1985","journal-title":"Am. J. Emerg. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.1097\/00003246-199512000-00007","article-title":"Systemic Perfusion Pressure and Blood Flow before and after Administration of Epinephrine during Experimental Cardiopulmonary Resuscitation","volume":"23","author":"Rubertsson","year":"1995","journal-title":"Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.resuscitation.2013.07.011","article-title":"The Prognostic Value of End Tidal Carbon Dioxide during Cardiac Arrest: A Systematic Review","volume":"84","author":"Touma","year":"2013","journal-title":"Resuscitation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.resuscitation.2020.12.002","article-title":"Cerebral Regional Oxygen Saturation during Cardiopulmonary Resuscitation and Return of Spontaneous Circulation: A Systematic Review and Meta-Analysis","volume":"159","author":"Sanfilippo","year":"2021","journal-title":"Resuscitation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1161\/01.CIR.69.4.822","article-title":"Mechanisms by Which Epinephrine Augments Cerebral and Myocardial Perfusion during Cardiopulmonary Resuscitation in Dogs","volume":"69","author":"Michael","year":"1984","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2017.12.003","article-title":"The Use of End-Tidal Carbon Dioxide (ETCO2) Measurement to Guide Management of Cardiac Arrest: A Systematic Review","volume":"123","author":"Paiva","year":"2018","journal-title":"Resuscitation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.resuscitation.2019.04.006","article-title":"End Tidal CO2 and Cerebral Oximetry for the Prediction of Return of Spontaneous Circulation during Cardiopulmonary Resuscitation","volume":"139","author":"Engel","year":"2019","journal-title":"Resuscitation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.resuscitation.2019.04.015","article-title":"Usefulness of Cerebral rSO2 Monitoring during CPR to Predict the Probability of Return of Spontaneous Circulation","volume":"139","author":"Takegawa","year":"2019","journal-title":"Resuscitation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.resuscitation.2015.07.024","article-title":"Carotid Doppler Blood Flow Measurement during Cardiopulmonary Resuscitation Is Feasible: A First in Man Study","volume":"96","author":"Adedipe","year":"2015","journal-title":"Resuscitation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101207","DOI":"10.1016\/j.resplu.2025.101207","article-title":"Detection of Return of Spontaneous Circulation during Cardiopulmonary Resuscitation Using Continuous Carotid Artery Doppler Blood Flow Monitored by AI in an Animal Model","volume":"27","author":"Mushunuri","year":"2026","journal-title":"Resusc. Plus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.jacc.2020.05.074","article-title":"Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week","volume":"76","author":"Teran","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1001\/jama.288.23.3035","article-title":"Resuscitation after Cardiac Arrest: A 3-Phase Time-Sensitive Model","volume":"288","author":"Weisfeldt","year":"2002","journal-title":"JAMA"},{"key":"ref_27","first-page":"S284","article-title":"Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Bartos","year":"2025","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e88","DOI":"10.1016\/j.bja.2020.04.057","article-title":"Impact of Capnography on Patient Safety in High- and Low-Income Settings: A Scoping Review","volume":"125","author":"Wollner","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_29","first-page":"100373","article-title":"Assessing the Cost-Effectiveness of Capnography for End-Tidal CO2 Monitoring during in-Hospital Cardiac Arrest: A Middle-Income Country Perspective Analysis","volume":"40","author":"Marzzani","year":"2024","journal-title":"Am. Heart J. 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