Physiology-directed cardiopulmonary resuscitation: advances in precision monitoring during cardiac arrest

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Purpose of reviewWe review the recent advances in physiologic monitoring during cardiac arrest and offer an evidence-based framework for prioritizing physiologic targets during cardiopulmonary resuscitation (CPR).Recent findingsCurrent CPR guidelines recommend a uniform approach for all patients in cardiac arrest, but newer data support a precision strategy that uses the individual patient's physiology to guide resuscitation. Coronary perfusion pressure and arterial DBP are associated with survival outcomes in recent animal and human studies. End-tidal carbon dioxide is a reasonable noninvasive alternative, but may be inferior to invasive hemodynamic endpoints. Cerebral oximetry and cardiac ultrasound are emerging physiologic indicators of CPR effectiveness.SummaryPhysiologic monitoring can and should be used to deliver precision CPR whenever possible and may improve outcomes after cardiac arrest.

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