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The optimal arterial pressure is not the same before and after the native heart returns. Treat the appearance of native ejection as a prompt to reassess the pressure target, not merely as good news.
Standard target, 65 to 75 mmHg
DOI 10.1186/s13054-021-03783-3
High mean arterial pressure target, 80 to 90 mmHg, by adrenaline titration
Six animals per group; anaesthetised model; adrenaline is itself cerebrally vasoactive and is the instrument used to separate the groups; abstract only.
During extracorporeal resuscitation the high target gave higher carotid flow and preserved autoregulation. After return of circulation the pattern inverted: lower carotid flow, higher intracranial pressure, sustained positive pressure reactivity index and reduced cerebral oxygen consumption in the high-target group.
Twelve pigs, six per group; 15 minutes untreated ventricular fibrillation, 30 minutes extracorporeal support at 40 mL/kg/min, then defibrillation to return of circulation and 2 hours of follow-up