Femoral artery diameter as an indicator of cardiopulmonary resuscitation quality: A secondary analysis of a porcine study

Abstract

Femoral artery ultrasound has the potential to be utilized for hemodynamic monitoring during cardiopulmonary resuscitation (CPR). This study evaluated the correlation between femoral artery diameter and established physiologic parameters during CPR, as well as the association between femoral artery diameter and return of spontaneous circulation (ROSC). A secondary analysis of a porcine ventricular fibrillation cardiac arrest model was conducted. The primary exposure was femoral artery diameter measured via ultrasound every 2 minutes during cardiac arrest. Physiologic parameters including diastolic blood pressure (DBP), end‐tidal carbon dioxide (ETCO2), coronary perfusion pressure (CoPP), and cerebral perfusion pressure (CePP) were recorded throughout the experiment. The primary outcome was the mean difference in femoral artery diameter between pigs with and without ROSC, analyzed using a linear mixed model. Correlation coefficients were calculated using a mixed‐model approach. A total of 199 data points from 22 pigs were analyzed, with a median femoral artery diameter of 2.6 mm (interquartile range: 2.1–3.5). Femoral artery diameter was significantly larger in pigs with ROSC than in those without ROSC (mean difference [95% confidence interval (CI)]: 0.9 mm [0.3–1.4], p ‐value = 0.004). Although DBP significantly differed between ROSC and non‐ROSC groups, ETCO2 levels did not. Femoral artery diameter showed moderate correlations with DBP ( r  = 0.66 [95% CI: 0.56–0.75]), CoPP ( r  = 0.64 [95% CI: 0.52–0.76]), and CePP ( r  = 0.69 [95% CI: 0.60–0.77]). Femoral artery diameter exhibited significant correlations with physiologic parameters, including DBP, CoPP, and CePP, and a larger diameter was associated with ROSC. Given its ease of measurement with minimal CPR interruption, femoral artery diameter may serve as a reliable indicator of CPR quality.