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Invasive Blood Pressure Monitoring During CPR

Question Type:
Intervention
Full Question:
In infants and children undergoing CPR (P), does does using invasive hemodynamic monitoring to titrate to a specific systolic/
diastolic blood pressure (I), compared with compared with not using invasive hemodynamic monitoring to titrate to a specific systolic/diastolic blood pressure (C), change survival to 180 days with good neurological outcome, survival to 60 days with good neurological outcome, survival to hospital discharge with good neurological outcome, the likelihood of survival to discharge, ROSC (O)?
Consensus on Science:
For the critical outcome of survival to 180 days and good neurologic outcome, we identified no studies. For the critical outcome of survival to 60 days and good neurologic outcome, we identified no studies. For the critical outcome of survival to hospital discharge and good neurologic outcome, we identified no studies. For the critical outcome of the likelihood of survival to discharge, we identified very-low-quality evidence (downgraded for risk of bias, very serious inconsistency, indirectness, and imprecision) from 2 pediatric animal RCTs(Friess 2013, 2698-2704; Sutton 2013, 696-701) involving 43 subjects, which showed benefit. For the important outcome of ROSC, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, very serious indirectness, and imprecision) from 2 pediatric animal RCTs(Friess 2013, 2698-2704; Sutton 2013, 696-701) involving 43 subjects, which showed benefit.
Treatment Recommendation:
The confidence in effect estimates is so low that the panel decided a recommendation was too speculative. Values, Preferences, and Task Force Insights In considering making a recommendation, the task force placed a higher value on establishing and maintaining high-quality CPR over the ability to invasively obtain hemodynamic values by which to further titrate CPR. The potential exists for interruption to and loss of focus on good CPR technique while patients are being invasively instrumented for intra-arterial monitoring. Although we conceptually value optimizing (monitored) hemodynamics during CPR, we recognize the potential for harm to patients by targeting a specific parameter that is informed only by unblinded animal data and subject to important confounding variables. Rescuers in advanced care settings with access to invasive arterial blood pressure monitoring may continue to use targets based on expert consensus recommendations.
CoSTR Attachments:
FINAL_Evidence Profile.docx    
FINAL_GradeGrid.xlsx    
Using invasive hemodynamic monitoring to titrate to a specific systolic.docx    

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