Randomized Trial of 3 CPR Strategies in a Pediatric Swine Cardiac Arrest Model With 7-Day Survival

Tuesday, March 24, 2026

8:55 AM - 9:55 AM Central Time

Location: Connections Central Theater 1

Jeremy R. Herrmann, MD

Children's Hospital of Philadelphia

Disclosure(s): No relevant financial relationship(s) to disclose.
RM

Ryan W. Morgan, MD, MTR

Associate Professor of Anesthesia and Critical Care
Children's Hospital of Philadelphia

Disclosure information not submitted.
TK

Tiffany Ko, PhD

Research Scientist
Children's Hospital of Philadelphia

Disclosure information not submitted.
RR

Ron W. Reeder, PhD

Professor of Pediatrics
University of Utah

Disclosure information not submitted.
Kumaran Senthil, MD (he/him/his)

Childrens Hospital of Philadelphia, Pennsylvania

Disclosure(s): No relevant financial relationship(s) to disclose.
AH

Adam S. Himebauch, MD, MSCE

Associate Professor of Anesthesia and Critical Care
Childrens Hospital of Philadelphia

Disclosure information not submitted.
RS

Robert Sutton, MD, FCCM

Professor, Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia

Disclosure information not submitted.
MM

McKenna L. Mason, n/a

Research Engineer
Children's Hospital of Philadelphia

Disclosure information not submitted.
MW

M Katie Weeks, n/a

Program Manager
Children's Hospital of Philadelphia

Disclosure information not submitted.
SK

Sarah Kenna, N/A

Lab Manager
Children's Hospital of Philadelphia

Disclosure information not submitted.
RB

Robert Berg, MD

Professor
Children's Hospital of Philadelphia

Disclosure information not submitted.
TK

Todd Kilbaugh, MD

Professor
University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.

Introduction: Hemodynamic-directed CPR (HD-CPR) improves intra-arrest hemodynamics and 24-hour survival outcomes. The increased vasoactive dosing in HD-CPR may worsen cerebral blood flow (CeBF). We hypothesized that 3 different CPR strategies may variably impact intra-arrest CeBF, post-arrest cardiac function, and 7-day outcomes.

Methods: 4-week-old swine (sus scrufa) underwent 7-minutes of asphyxia, induction of ventricular fibrillation arrest, and 15-min of CPR. Pigs were randomized to 3 CPR strategies (n=15 each). 1) HDhigh: a) chest compression depth (CCD) titrated to systolic BP ~110mmHg and b) vasoactives (epinephrine and vasopressin) titrated to diastolic BP ~45mmHg; 2) HDlow: BP titrated to ~80/30; 3) AHA: fixed CCD and vasoactive interval. Six shams underwent anesthesia and instrumentation without cardiac arrest. We assessed intra-arrest invasive laser doppler CeBF (normalized to pre-arrest flow; rCeBF), post-return of spontaneous circulation (ROSC) left ventricular (LV) systolic function by apical 4 strain and 7-day survival. Mixed-effect linear regression models with CPR group as a fixed effect, a spatial exponential covariance structure to account for repeated observations and post-hoc Tukey’s test or a Kruskal-Wallis tests were used.

Results: CCD differed among CPR strategies (overall P< 0.001; AHA vs HDhigh point estimate +4.4 +/- 1.8mm, P=0.06) as did vasoactive doses (HDhigh 9 [7-10] v. HDlow 8 [5-9] v. AHA 4 [4-4], p< 0.001). Intra-arrest rCeBF differed among groups (overall P=0.02; AHA vs HDhigh point estimate +40.2 +/- 14.5%, P=0.02) as did 1-hour post-ROSC LV function (HDhigh -15.7% [-19.8,-12.7] v. HDlow -13.9% [-16.4,-12.8] v. AHA -12.8% [-14.9,-9.5] v. sham -20.3% [-21.9, -17.5], p=0.025). 7-day survival did not differ among strategies (HDhigh 9/15 v. HDlow 5/15 v. AHA 7/15 [p=0.4]).

Conclusions: In this randomized preclinical trial of different physiology-directed and guideline-based resuscitation strategies, animals targeting the highest intra-arrest BP had more vasoactive doses and lower intra-arrest rCeBF compared to AHA CPR, yet improved post-ROSC cardiac function (more negative strain). There were no differences in 7-day survival. Future studies should evaluate optimal CPR strategies to improve ROSC, intra-arrest CBF, post-arrest cardiac and neurologic function.