Association between haemodynamics during cardiopulmonary resuscitation and cerebral arterial enhancement.

Aim: The extent to which antegrade or retrograde blood flow occurs during cardiopulmonary resuscitation (CPR) remains unclear. We investigated the relationship between arterial-venous pressure conditions during CPR and cerebral arterial enhancement on contrast-enhanced computed tomography (CT) to identify haemodynamic parameters associated with antegrade cerebral blood flow. Methods: This prospective observational single-centre study included adult patients with non-traumatic out-of-hospital cardiac arrest who did not achieve return of spontaneous circulation and underwent contrast-enhanced CT after CPR termination. Femoral arterial and venous pressures were continuously recorded during LUCAS 3-assisted chest compressions. Analysed parameters included arterial systolic (A sys), mean (A mean), diastolic (A dias) pressures, and arterial-venous pressure gradients (ΔSys A-V and ΔMean A-V). Contrast enhancement of the circle of Willis was evaluated. Results: Among 38 patients, 11 (29%) demonstrated contrast enhancement of the circle of Willis. Higher A sys, A mean, ΔSys A-V, and ΔMean A-V were significantly associated with cerebral arterial enhancement (all Conclusions: Higher arterial pressures and greater arterial-venous pressure gradients were associated with cerebral arterial enhancement during CPR, suggesting that a mean arterial-venous pressure gradient may be associated with antegrade cerebral perfusion and represent a physiological target for optimising resuscitation.