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Bouillon A, Vanwulpen M, Tackaert T, Cornelis R, Hachimi-Idrissi S. Explorative study on lower inflection point dynamics during cardiopulmonary resuscitation: Potential implications for airway management. Resuscitation 2024; 200:110242. [PMID: 38759718 DOI: 10.1016/j.resuscitation.2024.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION In patients undergoing cardiopulmonary resuscitation (CPR) after an Out-of-Hospital Cardiac Arrest (OHCA), intrathoracic airway closure can impede ventilation, adversely affecting patient outcomes. This explorative study investigates the evolution of intrathoracic airway closure by analyzing the lower inflection point (LIP) during the inspiration phase of CPR, aiming to identify the potential thresholds for alveolar recruitment. METHODS AND MATERIALS Eleven OHCA patients undergoing CPR with endotracheal intubation and manual bag ventilation were included. Flow and pressure measurements were obtained using Sensirion SFM3200AW and Wika CPT2500 sensors attached to the endotracheal tube, connected to a Surface Go Tablet for data collection. Flow data was analyzed in Microsoft Excel, while pressure data was processed using the Wika USBsoft2500 application. Analysis focused on the inspiration phase of the first 6-8 breaths, with an additional 2 breaths recorded and analyzed at the end of CPR. RESULTS Across the cohort, the median tidal volume was 870.00 milliliter (mL), average flow was 31.90 standard liters per minute (slm), and average pressure was 17.21 cmH2O. The calculated average LIP was 31.47 cmH2O. Most cases (72.7%) exhibited a negative trajectory in LIP evolution during CPR, with 2 cases (18.2%) showing a positive trajectory and 1 case remaining inconclusive. The average LIP in the first 8 breaths was significantly higher than in the last 2 breaths (p = 0.018). No significant correlation was found between average LIP and return of spontaneous circulation (ROSC), compression depth, frequency, or end-tidal CO2 (EtCO2). However, a significant negative correlation was observed between the average LIP of the last 2 breaths and CPR duration (p = 0.023). VALIDATION LIP calculation in low-flow ventilations using the novel mathematical method yielded values consistent with those reported in the literature. DISCUSSION/CONCLUSION These explorative data demonstrate a predominantly negative trajectory in LIP evolution during CPR, suggesting potential challenges in maintaining airway patency. Limitations include a small sample size and sensor recording issues. Further research is warranted to explore the evolution of LIP and its implications for personalized ventilation strategies in CPR.
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Affiliation(s)
- Arthur Bouillon
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium.
| | - Maxim Vanwulpen
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium; Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Thomas Tackaert
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
| | - Ruben Cornelis
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium
| | - Said Hachimi-Idrissi
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, Ghent, Belgium; Department of Emergency Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Bernard S, Pashun RA, Varma B, Yuriditsky E. Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest. J Clin Med 2024; 13:3527. [PMID: 38930056 PMCID: PMC11205151 DOI: 10.3390/jcm13123527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Given the high morbidity and mortality associated with cardiopulmonary arrest, there have been multiple trials aimed at better monitoring and augmenting coronary, cerebral, and systemic perfusion. This article aims to elucidate these interventions, first by detailing the physiology of cardiopulmonary resuscitation and the available tools for managing cardiopulmonary arrest, followed by an in-depth examination of the newest advances in the monitoring and delivery of advanced cardiac life support.
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Affiliation(s)
| | | | | | - Eugene Yuriditsky
- Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA; (S.B.); (R.A.P.)
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Shellen S, Parnia S, Huppert EL, Gonzales AM, Pollard K. Integrating rSO 2 and EEG monitoring in cardiopulmonary resuscitation: A novel methodology. Resusc Plus 2024; 18:100644. [PMID: 38708064 PMCID: PMC11066545 DOI: 10.1016/j.resplu.2024.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Despite improvements in cardiopulmonary resuscitation (CPR), survival and neurologic recovery after cardiac arrest remain poor due to ischemia and subsequent reperfusion injury. As the likelihood of survival and favorable neurologic outcome decreases with increasing severity of ischemia during CPR, developing methods to measure the magnitude of ischemia during resuscitation is critical for improving overall outcomes. Cerebral oximetry, which measures regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy, has emerged as a potentially beneficial marker of cerebral ischemia during CPR. In numerous preclinical and clinical studies, higher rSO2 during CPR has been associated with improved cardiac arrest survival and neurologic outcome. There is also emerging evidence that this can be integrated with electroencephalogram (EEG) monitoring to provide a bimodal system of brain monitoring during CPR. In this method's review, we discuss the feasibility, application, and implications of this integrated monitoring approach, highlighting its significance for improving clinical outcomes in cardiac arrest management and guiding future research directions.
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Affiliation(s)
- Samantha Shellen
- Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Sam Parnia
- Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
- Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Elise L. Huppert
- Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Anelly M. Gonzales
- Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Kenna Pollard
- Critical Care and Resuscitation Research Program, New York University Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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Sonmez E, Taslidere B, Ozkan A. A new method of pulse control in cardiopulmonary resuscitation; Continuous femoral pulse check. Am J Emerg Med 2024; 80:168-173. [PMID: 38613985 DOI: 10.1016/j.ajem.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES The reliability of manual pulse checks has been questioned but is still recommended in cardiopulmonary resuscitation (CPR) guidelines. The aim is to compare the 10-s carotid pulse check (CPC) between heart massage cycles with the continuous femoral pulse check (CoFe PuC) in CPR, and to propose a better location to shorten the interruption times for pulse check. METHODS A prospective study was conducted on 117 Non-traumatic CPR patients between January 2020 and January 2022. A total of 702 dependent pulse measurements were executed, where carotid and femoral pulses were simultaneously assessed. Cardiac ultrasound, end-tidal CO2, saturation, respiration, and blood pressure were employed for pulse validation. RESULTS The decision time for determining the presence of a pulse in the last cycle of CPR was 3.03 ± 1.26 s for CoFe PuC, significantly shorter than the 10.31 ± 5.24 s for CPC. CoFe PuC predicted the absence of pulse with 74% sensitivity and 88% specificity, while CPC predicted the absence of pulse with 91% sensitivity and 61% specificity. CONCLUSION CoFe PuC provides much earlier and more effective information about the pulse than CPC. This shortens the interruption times in CPR. CoFe PuC should be recommended as a new and useful method in CPR guidelines.
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Affiliation(s)
- E Sonmez
- Kütahya Health Sciences University, Medical School, Department of Emergency Medicine, Kütahya, Turkey
| | - B Taslidere
- Bezmialem Vakif University Medical Faculty, Department of Emergency Medicine, İstanbul, Turkey
| | - A Ozkan
- Bağcılar Training And Research Hospital, Department of Emergency Medicine, İstanbul, Turkey.
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Owens B, Hall C. Application of End-Tidal CO2 Monitoring to ICU Management. Crit Care Nurs Q 2024; 47:157-162. [PMID: 38419179 DOI: 10.1097/cnq.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Waveform capnography is a noninvasive measurement of ventilation and perfusion commonly employed in the prehospital setting. It is easy to apply, and modern cardiac monitors are equipped with the necessary ports and capability to display results. Despite its ease of use, end-tidal CO2 monitoring has not yet achieved widespread adoption within the hospital setting. It is routinely used in the emergency department and by anesthesiologists, but its application could support ICU management in critically ill patients. Its use is routinely supported by multiple professional societies, and it has been recommended as a requirement in all cardiac arrests. Careful analysis of the waveform and expired carbon dioxide can guide therapy for patients experiencing respiratory emergencies, hemodynamic compromise, metabolic acidosis, and shock due to trauma, hypovolemia, or sepsis. Use of capnography throughout the hospital could improve patient outcomes and prevent unidentified deterioration.
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Affiliation(s)
- Bradley Owens
- Allegheny General Hospital, Pittsburgh, Pennsylvania
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Wollner EA, Nourian MM, Bertille KK, Wake PB, Lipnick MS, Whitaker DK. Capnography-An Essential Monitor, Everywhere: A Narrative Review. Anesth Analg 2023; 137:934-942. [PMID: 37862392 DOI: 10.1213/ane.0000000000006689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.
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Affiliation(s)
- Elliot A Wollner
- From the Department of Anaesthesia and Perioperative Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ki K Bertille
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Pauline B Wake
- School of Medicine and Health Sciences, University of Papua New Guinea
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Medicine, Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - David K Whitaker
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, United Kingdom
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John MT, van Blydenstein SA, Omar S, Bruins J, Tshukutsoane S. Oxygen efficient respiratory Aid (OxEra TM) device: A safety study. Afr J Emerg Med 2022; 12:172-176. [PMID: 35611145 PMCID: PMC9121766 DOI: 10.1016/j.afjem.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/04/2022] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Africa is a continent that has many developing countries that have constant strain on their healthcare systems. Now with the COVID pandemic, the use of oxygen and need for cost efficient and safe oxygen devices has increased. OxEraTM is an oxygen delivery device that has been designed and developed by a consortium named Umoya for emergency use (approval from SAPHRA) in the COVID 19 pandemic. Given the potential for the widespread utilisation of this oxygen device in a resource-limited setting, we performed a clinical assessment safety study.
Background Severe Coronavirus Disease 2019 (COVID-19) can develop pneumonia with severe complications. The Oxygen Efficient Respiratory Aid (OxEraTM) device has been granted SAPHRA approval for emergency COVID-19 pandemic use. The device has the potential to be used widely in the healthcare sector due to its efficient oxygen supply and adjustable wall positive expiratory pressure (PEP). Objectives We assessed whether the OxEraTM device was safe to use in a healthy adult volunteer population. Our primary objective was to ensure there was no asphyxiation, as assessed by changes observed from baseline End Tidal Carbon Dioxide (ETCO2) exceeding 6.3 mmHg and above the 45 mmHg threshold. We also monitored changes in vital organ signs and assessed the pain and comfort of the participant at various intervals with changes in PEPs. Methods This was an experimental safety study of the OxEraTM Device on 30 healthy participants at the ICU training centre of Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Each participant had basic vital-signs, ETCO2, and Oxygen saturation percentages (SpO2%) taken at baseline until the end of 2 h. In the first 20 min, the PEP was increased by 5 cmH20 until 20 min, then continued for the rest of the time on a PEP of 5 cmH20. At each interval, vital signs, subjective comfort, pain, and visual scores were measured. Results Thirty healthy participants were enrolled. There was no significant difference in ETCO2 from baseline until 2 h. No participant experienced an increase in measured ETCO2 greater than 45 mmHg and no increase in ETCO2 from baseline was greater than 6.3 mmHg. The median increase in ETCO2 over the study period was 2 mmHg. There were no significant changes in respiratory rate and blood pressure. The heart rate decreased significantly (73–68 bpm). The VAS and comfort score had a significant increase over the 2 h from baseline of 0–2 at maximum; however, the PAS scores showed no significant increase. Conclusion Overall the OxEraTM device achieved the safety endpoints set out. There was no sign of asphyxiation and there were appropriate physiological responses to changes in PEP once applied. The comfort of the mask did worsen over the 2 h; however, the scores were minimally worse on PEP application but improved once-off PEP. No adverse event was recorded at all.
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Affiliation(s)
- Midhun Thomas John
- Internal Medicine Registrar, Chris Hani Baragwanath Hospital, Internal Medicine, University of Witwatersrand, South Africa
- Corresponding author.
| | | | - Shahed Omar
- Critical Care Physician, Chris Hani Baragwanath Hospital, ICU Department, University of Witwatersrand, South Africa
| | - Joanne Bruins
- Chris Hani Baragwanath Hospital, Internal Medicine, University of Witwatersrand, South Africa
| | - Stephilia Tshukutsoane
- Burns Hons, Critical Care Nurse, RM, RN. Chris Hani Baragwanath Academic Hospital, South Africa
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Portelli Tremont JN, Caldas RA, Cook N, Udekwu PO, Moore SM. Low initial in-hospital end-tidal carbon dioxide predicts poor patient outcomes and is a useful trauma bay adjunct. Am J Emerg Med 2022; 56:45-50. [DOI: 10.1016/j.ajem.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/11/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
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Moradian ST, Beitollahi F, Ghiasi MS, Vahedian-Azimi A. Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial. Front Surg 2022; 9:826761. [PMID: 35647019 PMCID: PMC9130597 DOI: 10.3389/fsurg.2022.826761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, p > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, p < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were significantly lower in the intervention group. However, the differences in the length of stay in ICU between the two groups were not significant (p = 0.219). Conclusion Our results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Clinical Trial Registration Current Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.
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Affiliation(s)
- Seyed Tayeb Moradian
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah university of Medical Sciences, Tehran, Iran
| | - Fatemah Beitollahi
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah university of Medical Sciences, Tehran, Iran
| | - Mohammad Saeid Ghiasi
- Atherosclerosis Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Correspondence: Amir Vahedian-Azimi
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Kim SH, Hong SJ. A prospective randomized controlled trial of the safety and efficacy of carbon dioxide insufflation compared with room air insufflation during gastric endoscopic submucosal dissection. J Gastroenterol Hepatol 2022; 37:558-567. [PMID: 34674397 DOI: 10.1111/jgh.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/03/2021] [Accepted: 10/08/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Carbon dioxide (CO2 ) insufflation during gastric endoscopic submucosal dissection (GESD) under sedation can be used instead of room air insufflation. Appropriate monitoring of the partial pressure of CO2 during GESD is necessary due to the impaired respiration. The aim of this study was to assess the safety and efficacy of CO2 insufflation during GESD compared with conventional room air insufflation. METHODS Patients with a gastric epithelial neoplasm or early gastric cancer were enrolled. A total of 76 consecutive patients were randomly assigned to the CO2 insufflation group (CO2 group) or the room air insufflation group (air group). The primary outcome was the mean difference of end-tidal CO2 (EtCO2 ) between two groups. RESULTS The upper bound of the 95% CI for the mean EtCO2 difference between the two groups before the procedure and at 15, 30 and 45 min after insufflation met the criteria for noninferiority. In a subgroup analysis of patients 70 years and older, the mean difference of EtCO2 was not significantly different between two groups. However, the air group received more analgesics than the CO2 group after the procedure (67.6% vs 35.1%, P = 0.005). In addition, in terms of improvement of abdominal pain or bowel gas after 24 h of GESD, CO2 group showed better results than air group (both P < 0.05). CONCLUSIONS CO2 insufflation during GESD is as safe as using room air, and patients, including elderly patients, receiving CO2 achieve more rapid relief of abdominal pain and intra-abdominal residual gas during and after the procedure.
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Affiliation(s)
- Shin Hee Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon, South Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon, South Korea
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Zhang L, Jin K, Sun F, Xu J, Yu X, Zhu H, Fu Y, Liu D, Yu S. Assessment of a new volumetric capnography-derived parameter to reflect compression quality and to predict return of spontaneous circulation during cardiopulmonary resuscitation in a porcine model. J Clin Monit Comput 2022; 36:199-207. [PMID: 33511562 DOI: 10.1007/s10877-020-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
We aimed to evaluate a volumetric capnography (Vcap)-derived parameter, the volume of CO2 eliminated per minute and per kg body weight (VCO2/kg), as an indicator of the quality of chest compression (CC) and to predict the return to spontaneous circulation (ROSC) under stable ventilation status. Twelve male domestic pigs were utilized for the randomized crossover study. After 4 min of untreated ventricular fibrillation (VF), mechanical cardiopulmonary resuscitation and ventilation were administered. Following 5-min washout periods, each animal underwent two sessions of experiments: three types of CC quality for 5 min stages in the first session, followed by advanced life support, consecutively in two sessions. Different CC quality had a significant effect on the partial pressure of end-tidal carbon dioxide (PetCO2), VCO2/kg, aortic pressure (mean), aortic systolic pressure, aortic diastolic pressure, right atrial pressure (mean), and carotid blood flow (P < 0.05). With the improvement in CC quality, the values of PetCO2 and VCO2/kg also increased, and the difference between the groups was statistically significant (P < 0.05). The Spearman rank test revealed a significant correlation between the Vcap-derived parameters and hemodynamics. PetCO2 and VCO2/kg have similar capabilities for discriminating survivors from non-survivors, and the area under the curve for both was 0.97. VCO2/kg had similar performance as PetCO2 in reflecting the quality of CC and prediction of achieving ROSC under stable ventilation status in a porcine model of VF-related cardiac arrest. However, VCO2/kg requires a longer time to achieve a stable state after adjusting for quality of CC than PetCO2.
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Affiliation(s)
- Lili Zhang
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Kui Jin
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Feng Sun
- Emergency Department, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Danyu Liu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Shanshan Yu
- Emergency Department, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
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Hong SI, Kim JS, Kim YJ, Kim WY. Dynamic changes in arterial blood gas during cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Sci Rep 2021; 11:23165. [PMID: 34848833 PMCID: PMC8632901 DOI: 10.1038/s41598-021-02764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to investigate the prognostic value of dynamic changes in arterial blood gas analysis (ABGA) measured after the start of cardiopulmonary resuscitation (CPR) for return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). This prospective observational study was conducted at the emergency department of a university hospital from February 2018 to February 2020. All blood samples for gas analysis were collected from a radial or femoral arterial line, which was inserted during CPR. Changes in ABGA parameters were expressed as delta (Δ), defined as the values of the second ABGA minus the values of the initial ABGA. The primary outcome was sustained ROSC. Out of the 80 patients included in the analysis, 13 achieved sustained ROSC after in-hospital resuscitation. Multivariable logistic analysis revealed that ΔpaO2 (odds ratio [OR] = 1.023; 95% confidence interval [CI] = 1.004–1.043, p = 0.020) along with prehospital shockable rhythm (OR = 84.680; 95% CI = 2.561–2799.939, p = 0.013) and total resuscitation duration (OR = 0.881; 95% CI = 0.805–0.964, p = 0.006) were significant predictors for sustained ROSC. Our study suggests a possible association between ΔpaO2 in ABGA during CPR and an increased rate of sustained ROSC in the late phase of OHCA.
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Affiliation(s)
- Seok-In Hong
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - June-Sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Korea.
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Donoghue A, Navarro K, Diederich E, Auerbach M, Cheng A. Deliberate practice and mastery learning in resuscitation education: A scoping review. Resusc Plus 2021; 6:100137. [PMID: 34223392 PMCID: PMC8244416 DOI: 10.1016/j.resplu.2021.100137] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY AIM To summarize the current state of knowledge of deliberate practice and mastery learning (DP and/or ML) as teaching methods for resuscitation education. METHODS A scoping review of PubMed, Scopus, and Embase was conducted through March 1, 2021. Studies examining the effect of the incorporation of either deliberate practice and/or mastery learning during resuscitation education were eligible for inclusion. Included studies were dichotomized into studies comparing deliberate practice and/or mastery learning to other training methods (randomized controlled trials) and studies examining before and after impact of deliberate practice and/or mastery learning alone (observational studies). Studies and findings were tabulated and summarized using the scoping review methodology published by Arksey and O'Malley. RESULTS 63 published studies were screened; sixteen studies met all inclusion criteria (4 randomized controlled trials and 12 observational studies). One randomized controlled trial and eleven observational studies demonstrated improvement in skill and/or knowledge following educational interventions using deliberate practice and/or mastery learning. Significant variability between studies with regard to research designs, learner groups, comparators, and outcomes of interest made quantitative summarization of findings difficult. CONCLUSIONS The incorporation of deliberate practice and/or mastery learning in resuscitation education may be associated with improved educational outcomes and less skill decay than other educational methods. Current literature on DP and ML suffers from a lack of consistency in research methodology, subjects, and outcomes. Future research should employ uniform definitions for deliberate practice and mastery learning, follow research design that isolates its effect, and examine generalizable and translatable outcomes.
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Key Words
- ACLS, advanced cardiac life support
- AED, automated external defibrillator
- ALS, advanced life support
- BLS, basic life support
- CPR, cardiopulmonary resuscitation
- Cardiopulmonary resuscitation
- DP, deliberate practice
- Deliberate practice, mastery learning
- Life support education
- ML, mastery learning
- NRP, neonatal resuscitation program
- PALS, pediatric advanced life support
- RCT, randomized controlled trial
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Affiliation(s)
- Aaron Donoghue
- Divisions of Critical Care Medicine and Emergency Medicine, Departments of Anesthesia and Critical Care Medicine and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Navarro
- Division of EMS, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily Diederich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Marc Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale University, New Haven, CT, USA
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, Canada
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Zhang L, Liang X, Zhu H, Yin L, Dai J, Liu D, Yu S, Fu Y, Jin K, Xu J, Yu X. New volumetric capnography-derived parameter: a potentially valuable tool for detecting hyperventilation during cardiopulmonary resuscitation in a porcine model. J Thorac Dis 2021; 13:3467-3477. [PMID: 34277042 PMCID: PMC8264707 DOI: 10.21037/jtd-21-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022]
Abstract
Background Volumetric capnography is increasingly being applied in cardiopulmonary resuscitation. However, during cardiopulmonary resuscitation, the abnormal ventilation state affects the monitoring effect of the most commonly used capnography-derived parameter, the partial carbon dioxide end-tidal pressure (PetCO2). In this study, we evaluated the ability of a new volumetric capnography-derived parameter, the ratio between the PetCO2 and the volume of carbon dioxide (CO2) eliminated per min and per kilogram of body weight, for detecting hyperventilation during cardiopulmonary resuscitation. Methods We used 12 porcine models of primary ventricular fibrillation-induced cardiac arrest. Ventricular fibrillation was induced and left untreated for 4 min. Standardized chest compressions were performed throughout the experiment using mechanical cardiopulmonary resuscitation. Following 5 min of normal ventilation as a washout period, each animal underwent 4 types of ventilation. The main outcome measures were the PetCO2, the ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight with each ventilation type. Results Different ventilation types had a significant effect on the volumetric capnography-derived parameters. The PetCO2 and ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight values during cardiopulmonary resuscitation was significantly higher in non-hyperventilating than in hyperventilating animals. The ratio reflected hyperventilation accurately and immediately, with an area under the curve (AUC) of 0.98. The optimal cut-off point of the ratio for discriminating hyperventilation from non-hyperventilation was 6.36, with a sensitivity and specificity of 0.99 and 0.89, respectively. Conclusions The ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight showed good performance in discriminating hyperventilation from non-hyperventilation and was sensitive to changes in ventilation status. This ratio may be a valuable clinical indicator for monitoring the ventilation status during cardiopulmonary resuscitation.
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Affiliation(s)
- Lili Zhang
- The Second People's Hospital of Guiyang, Guiyang, China
| | | | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Yin
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiayuan Dai
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Danyu Liu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Yu
- The Second People's Hospital of Guiyang, Guiyang, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kui Jin
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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15
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Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation. PLoS One 2021; 16:e0251511. [PMID: 34003839 PMCID: PMC8130954 DOI: 10.1371/journal.pone.0251511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background Measurement of end-tidal CO2 (ETCO2) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO2 variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO2 during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. Methods We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO2 between consecutive ventilations was computed and its average value, ΔETavg, was used as a single feature to discriminate between ROSC and non-ROSC segments. Results A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔETavg was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. Conclusion Average percent variation of ETCO2 during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings.
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16
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Cereceda-Sánchez FJ, Molina-Mula J. Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review. Aust Crit Care 2021; 34:287-295. [PMID: 33069590 DOI: 10.1016/j.aucc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography. OBJECTIVE The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices. REVIEW METHODS USED This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols. DATA SOURCES A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019. REVIEW METHODS Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme. RESULTS Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation. CONCLUSIONS The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.
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Affiliation(s)
| | - Jesús Molina-Mula
- University of Balearic Islands, Ctra. de Valldemossa, km 7.5, Palma (Islas Baleares), Spain
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17
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Cereceda-Sánchez FJ, Molina-Mula J. Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review. Aust Crit Care 2021. [DOI: https://doi.org/10.1016/j.aucc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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18
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Aggelina A, Pantazopoulos I, Giokas G, Chalkias A, Mavrovounis G, Papalois A, Douvanas A, Xanthos T, Iacovidou N. Continuous chest compressions with asynchronous ventilation improve survival in a neonatal swine model of asphyxial cardiac arrest. Am J Emerg Med 2021; 48:60-66. [PMID: 33839633 DOI: 10.1016/j.ajem.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Guidelines for neonatal resuscitation recommend a 3:1 compression to ventilation ratio. However, this recommendation is based on expert opinion and consensus rather than strong scientific evidence. Our primary aim was to assess whether continuous chest compressions with asynchronous ventilations would increase return of spontaneous circulation (ROSC) rate and survival compared to the 3:1 chest compression to ventilation ratio. METHODS This was a prospective, randomized, laboratory study. Twenty male Landrace-Large White pigs, aged 1-4 days with an average weight 1.650 ± 228.3 g were asphyxiated and left untreated until heart rate was less than 60 bpm or mean arterial pressure was below 15 mmHg. Animals were then randomly assigned to receive either continuous chest compressions with asynchronous ventilations (n = 10), or standard (3:1) chest compression to ventilation ratio (n = 10). Heart rate and arterial pressure were assessed every 30 s during cardiopulmonary resuscitation (CPR) until ROSC or asystole. All animals with ROSC were monitored for 4 h. RESULTS Coronary perfusion pressure (CPP) at 30 s of CPR was significantly higher in the experimental group (45.7 ± 16.9 vs. 21.8 ± 6 mmHg, p < 0.001) and remained significantly elevated throughout the experiment. End-tidal carbon dioxide (ETCO2) was also significantly higher in the experimental group throughout the experiment (23.4 ± 5.6 vs. 14.7 ± 5.9 mmHg, p < 0.001). ROSC was observed in six (60%) animals treated with 3:1 compression to ventilation ratio and nine (90%) animals treated with continuous chest compressions and asynchronous ventilation (p = 0.30). Time to ROSC was significantly lower in the experimental group (30 (30-30) vs. 60 (60-60) sec, p = 0.021). Of note, 7 (77.8%) animals in the experimental group and 1 (16.7%) animal in the control group achieved ROSC after 30 s (0.02). At 4 h, 2 (20%) animals survived in the control group compared to 7 (70%) animals in the experimental group (p = 0.022). CONCLUSION Continuous chest compressions with asynchronous ventilations significantly improved CPP, ETCO2, time to ROSC, ROSC at 30 s and survival in a porcine model of neonatal resuscitation.
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Affiliation(s)
- Afrodite Aggelina
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Ioannis Pantazopoulos
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece
| | - George Giokas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | - Athanasios Chalkias
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Anesthesiology, 41110 Larissa, Greece
| | - Georgios Mavrovounis
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Department of Emergency Medicine, 41110 Larissa, Greece.
| | - Apostolos Papalois
- Experimental, Educational and Research Center ELPEN, Greece; European University Cyprus, School of Medicine, 1516, Cyprus.
| | - Alexandros Douvanas
- National & Kapodistrian University of Athens, School of Medicine, 11527, Greece
| | | | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, 11527, Greece; Department of Neonatology, Aretaieio Hospital, 11528, Greece
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19
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Buléon C, Parienti JJ, Morilland-Lecoq E, Halbout L, Cesaréo E, Dubien PY, Jardel B, Boyer C, Husson K, Andriamirado F, Benet X, Morel-Marechal E, Aubrion A, Muntean C, Dupire E, Roupie E, Hubert H, Vilhelm C, Gueugniaud PY. Impacts of chest compression cycle length and real-time feedback with a CPRmeter® on chest compression quality in out-of-hospital cardiac arrest: study protocol for a multicenter randomized controlled factorial plan trial. Trials 2020; 21:627. [PMID: 32641090 PMCID: PMC7346361 DOI: 10.1186/s13063-020-04536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background With a survival rate of 6 to 11%, out-of-hospital cardiac arrest (OHCA) remains a healthcare challenge with room for improvement in morbidity and mortality. The guidelines emphasize the highest possible quality of cardiopulmonary resuscitation (CPR) and chest compressions (CC). It is essential to minimize CC interruptions, and therefore increase the chest compression fraction (CCF), as this is an independent factor for survival. Survival is significantly and positively correlated with the suitability of CCF targets, CC frequency, CC depth, and brief predefibrillation pause. CC guidance improves adherence to recommendations and allows closer alignment with the CC objectives. The possibility of improving CCF by lengthening the time between two CC relays and the effect of real-time feedback on the quality of the CC must be investigated. Methods Using a 2 × 2 factorial design in a multicenter randomized trial, two hypotheses will be tested simultaneously: (i) a 4-min relay rhythm improves the CCF (reducing the no-flow time) compared to the currently recommended 2-min relay rate, and (ii) a guiding tool improves the quality of CC. Primary outcomes (i) CCF and (ii) correct compression score will be recorded by a real-time feedback device. Five hundred adult nontraumatic OHCAs will be included over 2 years. Patients will be randomized in a 1:1:1:1 distribution receiving advanced CPR as follows: 2-min blind, 2 min with guidance, 4-min blind, or 4 min with guidance. Secondary outcomes are the depth, frequency, and release of CC; length (care, no-flow, and low-flow); rate of return of spontaneous circulation; characteristics of advanced CPR; survival at hospital admission; survival and neurological state on days 1 and 30 (or intensive care discharge); and dosage of neuron-specific enolase on days 1 and 3. Discussion This study will contribute to assessing the impact of real-time feedback on CC quality in practical conditions of OHCA resuscitation. It will also provide insight into the feasibility of extending the relay rhythm between two rescuers from the currently recommended 2 to 4 min. Trial registration ClinicalTrials.gov, NCT03817892. Registered on 28 January 2019
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Affiliation(s)
- Clément Buléon
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.
| | - Jean-Jacques Parienti
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Elodie Morilland-Lecoq
- UNICAEN, CHU de Caen Normandie, Unité de Biostatistiques et de Recherche Clinique, Normandie University, 14000, Caen, France
| | - Laurent Halbout
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Eric Cesaréo
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Pierre-Yves Dubien
- Department of Emergency Medicine, SAMU 69, Hospital Edouard Herriot, University Hospital of Lyon, Lyon, France
| | - Benoit Jardel
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France
| | | | - Kévin Husson
- Emergency Medicine Department and SAMU 59, Lille University Hospital, Lille, France
| | | | - Xavier Benet
- Emergency Department, Centre Hospitalier du Havre, Le Havre, France
| | | | - Antoine Aubrion
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France.,Emergency Department, Centre Hospitalier de Lisieux, Lisieux, France
| | - Catalin Muntean
- Emergency Department, Centre Hospitalier de Cherbourg, Cherbourg, France
| | - Erwan Dupire
- Emergency Department, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eric Roupie
- UNICAEN, CHU de Caen Normandie, Pôle Réanimations-Anesthésie-SAMU, Normandie University, 14000, Caen, France
| | - Hervé Hubert
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Christian Vilhelm
- University Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000, Lille, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
| | - Pierre-Yves Gueugniaud
- Department of Anaesthesiology and Intensive Care, SAMU 76, Rouen University Hospital, Rouen Cedex, France.,French National Out-of-Hospital Cardiac Arrest Registry Research Group, Registre Électronique des Arrêts Cardiaques, Lille, France
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20
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Ruiz de Gauna S, Gutiérrez JJ, Ruiz J, Leturiondo M, Azcarate I, González-Otero DM, Corcuera C, Russell JK, Daya MR. The impact of ventilation rate on end-tidal carbon dioxide level during manual cardiopulmonary resuscitation. Resuscitation 2020; 156:215-222. [PMID: 32622015 DOI: 10.1016/j.resuscitation.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
AIM Ventilation rate is a confounding factor for interpretation of end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR). The aim of our study was to model the effect of ventilation rate on ETCO2 during manual CPR in adult out-of-hospital cardiac arrest (OHCA). METHODS We conducted a retrospective analysis of OHCA monitor-defibrillator files with concurrent capnogram, compression depth, transthoracic impedance and ECG. We annotated pairs of capnogram segments presenting differences in average ventilation rate and average ETCO2 value but with other influencing factors (e.g. compression rate and depth) presenting similar values within the pair. ETCO2 variation as a function of ventilation rate was adjusted through curve fitting using non-linear least squares as a measure of goodness of fit. RESULTS A total of 141 pairs of segments from 102 patients were annotated. Each pair provided a single data point for curve fitting. The best goodness of fit yielded a coefficient of determination R2 of 0.93. Our model described that ETCO2 decays exponentially with increasing ventilation rate. The model showed no differences attributable to the airway type (endotracheal tube or supraglottic King-LT-D). CONCLUSION Capnogram interpretation during CPR is challenging since many factors influence ETCO2. For adequate interpretation, we need to know the effect of each factor on ETCO2. Our model allows quantifying the effect of ventilation rate on ETCO2 variation. Our findings could contribute to better interpretation of ETCO2 during CPR.
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Affiliation(s)
| | | | - Jesus Ruiz
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | - Mikel Leturiondo
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | - Izaskun Azcarate
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
| | | | - Carlos Corcuera
- Emergentziak-Osakidetza, Basque Country Health System, Basque Country, Spain
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21
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Leturiondo M, Ruiz de Gauna S, Gutiérrez JJ, Alonso D, Corcuera C, Urtusagasti JF, González-Otero DM, Russell JK, Daya MR, Ruiz JM. Chest compressions induce errors in end-tidal carbon dioxide measurement. Resuscitation 2020; 153:195-201. [PMID: 32492455 DOI: 10.1016/j.resuscitation.2020.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/17/2020] [Accepted: 05/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Real-time measurement of end-tidal carbon dioxide (ETCO2) is used as a non-invasive estimate of cardiac output and perfusion during cardiopulmonary resuscitation (CPR). However, capnograms are often distorted by chest compressions (CCs) and this may affect ETCO2 measurement. The aim of the study was to quantify the effect of CC-artefact on the accuracy of ETCO2 measurements obtained during out-of-hospital manual CPR. METHODS We retrospectively analysed monitor-defibrillator recordings collected by two advanced life support agencies during out-of-hospital cardiac arrest. These two agencies, represented as A and B used different side-stream capnometers and monitor-defibrillators. One-minute capnogram segments were reviewed. Each ventilation within each segment was identified using the transthoracic impedance signal and the capnogram. ETCO2 values per ventilation were manually annotated and compared to the corresponding capnometry values stored in the monitor-defibrillator. Ventilations were classified as distorted or non-distorted by CC-artefact. RESULTS A total of 407 1-min capnogram segments from 65 patients were analysed. Overall, 4095 ventilations were annotated, 2170 (32.4% distorted) and 1925 (31.8% distorted) for agency A and B, respectively. Median (IQR) unsigned error in ETCO2 measurement increased from 1.5 (0.6-3.1)% for non-distorted to 5.5 (1.8-14.1)% for distorted ventilations; from 0.7 (0.3-1.2)% to 3.7 (1.0-9.9)% in agency A and from 2.3 (1.2-3.9)% to 8.3 (3.9-19.5)% in agency B (p < 0.001). Errors were higher than 10 mmHg in 9% and higher than 15 mmHg in 5% of the distorted ventilations. CONCLUSION CC-artefact causes ETCO2 measurement errors in the two studied devices. This suggests that capnometer algorithms may need to be adapted to reliably perform in the presence of CC-artefact during CPR.
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Affiliation(s)
- Mikel Leturiondo
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain.
| | | | | | - Daniel Alonso
- Emergentziak-Osakidetza, Basque Country Health System, Basque Country, Spain
| | - Carlos Corcuera
- Emergentziak-Osakidetza, Basque Country Health System, Basque Country, Spain
| | | | | | | | | | - Jesus María Ruiz
- University of the Basque Country, UPV/EHU, Bilbao, Bizkaia, Spain
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22
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Calheiros J, Charco-Mora P. Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:316-324. [PMID: 32143822 DOI: 10.1016/j.redar.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.
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Affiliation(s)
- J Calheiros
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal.
| | - P Charco-Mora
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
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Niveles de capnometría como indicador de evolución de injerto renal de donantes en asistolia no controlada. Med Intensiva 2020; 44:233-238. [DOI: 10.1016/j.medin.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022]
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Wollner E, Nourian MM, Booth W, Conover S, Law T, Lilaonitkul M, Gelb AW, Lipnick MS. Impact of capnography on patient safety in high- and low-income settings: a scoping review. Br J Anaesth 2020; 125:e88-e103. [PMID: 32416994 DOI: 10.1016/j.bja.2020.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Capnography is universally accepted as an essential patient safety monitor in high-income countries (HICs) yet is often unavailable in low and middle-income countries (LMICs). Increasing capnography availability has been proposed as one of many potential approaches to improving perioperative outcomes in LMICs. This scoping review summarises the existing literature on the effect of capnography on patient outcomes to help prioritise interventions and guide expansion of capnography in LMICs. METHODS We searched MEDLINE and EMBASE databases for articles published between 1980 and March 2019. Studies that assessed the impact of capnography on morbidity, mortality, or the use of airway interventions both inside and outside the operating room were included. RESULTS The search resulted in 7445 unique papers, and 31 were included for analysis. Retrospective and non-randomised data suggest capnography use may improve outcomes in the operating room, ICU, and emergency department, and during resuscitation. Prospective data on capnography use for procedural sedation suggest earlier detection of hypoventilation and a reduction in haemoglobin desaturation events. No randomised studies exist that assess the impact of capnography on patient outcomes. CONCLUSION Despite widespread endorsement of capnography as a mandatory perioperative monitor, rigorous data demonstrating its impact on patient outcomes are limited, especially in LMICs. The association between capnography use and a reduction in serious airway complications suggests that closing the capnography gap in LMICs may represent a significant opportunity to improve patient safety. Additional data are needed to quantify the global capnography gap and better understand the barriers to capnography scale-up in LMICs.
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Affiliation(s)
- Elliot Wollner
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
| | - Maziar M Nourian
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Booth
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Sophia Conover
- Medical Libraries, University of California San Francisco, San Francisco, CA, USA
| | - Tyler Law
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Maytinee Lilaonitkul
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Adrian W Gelb
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Lipnick
- Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
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Personalized physiology-guided resuscitation in highly monitored patients with cardiac arrest-the PERSEUS resuscitation protocol. Heart Fail Rev 2020; 24:473-480. [PMID: 30741366 DOI: 10.1007/s10741-019-09772-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Resuscitation guidelines remain uniform across all cardiac arrest patients, focusing on the delivery of chest compressions to a standardized rate and depth and algorithmic vasopressor dosing. However, individualizing resuscitation to the appropriate hemodynamic and ventilatory goals rather than a standard "one-size-fits-all" treatment seems a promising new therapeutic strategy. In this article, we present a new physiology-guided treatment strategy to titrate the resuscitation efforts to patient's physiologic response after cardiac arrest. This approach can be applied during resuscitation attempts in highly monitored patients, such as those in the operating room or the intensive care unit, and could serve as a method for improving tissue perfusion and oxygenation while decreasing post-resuscitation adverse effects.
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Ventilation Is an Important Confounding Variable When End-Tidal Carbon Dioxide Is Used to Help Guide Cardiopulmonary Resuscitation. Anesth Analg 2020; 129:1436-1438. [PMID: 31490249 DOI: 10.1213/ane.0000000000004409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest. PLoS One 2020; 15:e0228395. [PMID: 32023298 PMCID: PMC7001922 DOI: 10.1371/journal.pone.0228395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/14/2020] [Indexed: 01/17/2023] Open
Abstract
Aim Current resuscitation guidelines recommend waveform capnography as an indirect indicator of perfusion during cardiopulmonary resuscitation (CPR). Chest compressions (CCs) and ventilations during CPR have opposing effects on the exhaled carbon dioxide (CO2) concentration, which need to be better characterized. The purpose of this study was to model the impact of ventilations in the exhaled CO2 measured from capnograms collected during out-of-hospital cardiac arrest (OHCA) resuscitation. Methods We retrospectively analyzed OHCA monitor-defibrillator files with concurrent capnogram, compression depth, transthoracic impedance and ECG signals. Segments with CC pauses, two or more ventilations, and with no pulse-generating rhythm were selected. Thus, only ventilations should have caused the decrease in CO2 concentration. The variation in the exhaled CO2 concentration with each ventilation was modeled with an exponential decay function using non-linear-least-squares curve fitting. Results Out of the original 1002 OHCA dataset (one per patient), 377 episodes had the required signals, and 196 segments from 96 patients met the inclusion criteria. Airway type was endotracheal tube in 64.8% of the segments, supraglottic King LT-D™ in 30.1%, and unknown in 5.1%. Median (IQR) decay factor of the exhaled CO2 concentration was 10.0% (7.8 − 12.9) with R2 = 0.98(0.95 − 0.99). Differences in decay factor with airway type were not statistically significant (p = 0.17). From these results, we propose a model for estimating the contribution of CCs to the end-tidal CO2 level between consecutive ventilations and for estimating the end-tidal CO2 variation as a function of ventilation rate. Conclusion We have modeled the decrease in exhaled CO2 concentration with ventilations during chest compression pauses in CPR. This finding allowed us to hypothesize a mathematical model for explaining the effect of chest compressions on ETCO2 compensating for the influence of ventilation rate during CPR. However, further work is required to confirm the validity of this model during ongoing chest compressions.
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Cardiac arrest without pulse checks. Resuscitation 2020; 147:112-113. [DOI: 10.1016/j.resuscitation.2019.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
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Grieco DL, J Brochard L, Drouet A, Telias I, Delisle S, Bronchti G, Ricard C, Rigollot M, Badat B, Ouellet P, Charbonney E, Mancebo J, Mercat A, Savary D, Richard JCM. Intrathoracic Airway Closure Impacts CO 2 Signal and Delivered Ventilation during Cardiopulmonary Resuscitation. Am J Respir Crit Care Med 2020; 199:728-737. [PMID: 30257100 DOI: 10.1164/rccm.201806-1111oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE End-tidal CO2 (EtCO2) is used to monitor cardiopulmonary resuscitation (CPR), but it can be affected by intrathoracic airway closure. Chest compressions induce oscillations in expired CO2, and this could reflect variable degrees of airway patency. OBJECTIVES To understand the impact of airway closure during CPR, and the relationship between the capnogram shape, airway closure, and delivered ventilation. METHODS This study had three parts: 1) a clinical study analyzing capnograms after intubation in patients with out-of-hospital cardiac arrest receiving continuous chest compressions, 2) a bench model, and 3) experiments with human cadavers. For 2 and 3, a constant CO2 flow was added in the lung to simulate CO2 production. Capnograms similar to clinical recordings were obtained and different ventilator settings tested. EtCO2 was compared with alveolar CO2 (bench). An airway opening index was used to quantify chest compression-induced expired CO2 oscillations in all three clinical and experimental settings. MEASUREMENTS AND MAIN RESULTS A total of 89 patients were analyzed (mean age, 69 ± 15 yr; 23% female; 12% of hospital admission survival): capnograms exhibited various degrees of oscillations, quantified by the opening index. CO2 value varied considerably across oscillations related to consecutive chest compressions. In bench and cadavers, similar capnograms were reproduced with different degrees of airway closure. Differences in airway patency were associated with huge changes in delivered ventilation. The opening index and delivered ventilation increased with positive end-expiratory pressure, without affecting intrathoracic pressure. Maximal EtCO2 recorded between ventilator breaths reflected alveolar CO2 (bench). CONCLUSIONS During chest compressions, intrathoracic airway patency greatly affects the delivered ventilation. The expired CO2 signal can reflect CPR effectiveness but is also dependent on airway patency. The maximal EtCO2 recorded between consecutive ventilator breaths best reflects alveolar CO2.
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Affiliation(s)
- Domenico L Grieco
- 1 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,3 Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laurent J Brochard
- 1 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Adrien Drouet
- 4 SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | - Irene Telias
- 1 Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Gilles Bronchti
- 6 Laboratoire d'anatomie, Université du Québec à Trois-Rivières et CIUSSS MCQ, Trois-Rivières, Canada
| | - Cecile Ricard
- 4 SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | | | - Bilal Badat
- 7 Air Liquide Medical Systems, Antony, France
| | - Paul Ouellet
- 8 Vitalité Health Network, North West Zone, Edmundston, Canada
| | - Emmanuel Charbonney
- 5 Université de Montréal, Montreal, Canada.,6 Laboratoire d'anatomie, Université du Québec à Trois-Rivières et CIUSSS MCQ, Trois-Rivières, Canada
| | - Jordi Mancebo
- 9 Department of Intensive Care, Sant Pau University Hospital, Barcelona, Spain
| | - Alain Mercat
- 10 Critical Care Department, Angers University Hospital, Angers, France; and
| | - Dominique Savary
- 4 SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | - Jean-Christophe M Richard
- 4 SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France.,11 INSERM UMR 1066, Créteil, France
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Gadzhiev N, Oibolatov U, Kolotilov L, Parvanyan S, Akopyan G, Petrov S, Cottone CM, Sung J, Okhunov Z. Reducing kidney motion: optimizing anesthesia and combining respiratory support for retrograde intrarenal surgery: a pilot study. BMC Urol 2019; 19:61. [PMID: 31277626 PMCID: PMC6612185 DOI: 10.1186/s12894-019-0491-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the greatest challenges presented with RIRS is the potential for movement of the stone within the operative field associated with diaphragm and chest respiratory excursions due to mechanical ventilation. To overcome this challenge, we propose in this pilot study a new general anesthesia technique combining high frequency jet ventilation (HFJV) with small volume mechanical ventilation (SVMV). Data regarding safety, feasibility and surgeons' impression was assessed. METHODS Patients undergoing RIRS for kidney stones from November 2017 to May 2018 were prospectively recruited to participate in the study. In each case after the beginning of general anesthesia (GA) with mechanical ventilation (MV) surgeons were asked to assess the mobility of the operative field and conditions for laser lithotripsy according to the developed questionnaire scale. The questionnaire consisted of 5 degrees of assessment of kidney mobility and each question was scored from 1 to 5, 1 being very mobile (extremely poor conditions for dusting) and 5 completely immobile (Ideal conditions for dusting). After the assessment GA was modified with combined respiratory support (CRS), reducing tidal volume and respiratory rate (small volume mechanical ventilation, SVMV) and applying in the same time transcatheter high frequency jet ventilation (HFJV) inside the closed circuit. After beginning of CRS, surgeons were once again asked to assess the mobility of the operative field and the conditions for laser lithotripsy. Main ventilation parameters were recorded and compared in both regimens. RESULTS A total of 38 patients were included in the study. The mean age was 49 (range 45-53) with a mean stone size of 10 mm (range 10-14) and Hounsfield unit of 1060 (range 930-1190). All patients underwent successful RIRS and no intraoperative complications occurred throughout the duration of the study. A statistically significant difference between ventilation parameters prior to and after CRS institution was detected in all cases, however their clinical impact was negligible. Despite this, assessment via the questionnaire scale point values varied significantly before and after the application of CRS and were 2.3 (2.1; 2.6) and 3.8 (3.7; 4.0) respectively (p < 0.001). CONCLUSIONS The novel combined respiratory approach consisting of HFJV and SVMV appears to provide better conditions for stone dusting through reduced respiratory kidney motion and is not associated with adverse health effects or complications. TRIAL REGISTRATION NCT03999255 , date of registration: 25th June 2019 (retrospectively registered).
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Affiliation(s)
- Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Lva Tolstogo 17, Saint-Petersburg, Russian Federation, 197342
| | - Ullubiy Oibolatov
- Department of Anesthesiology, The Nikiforov Center of Emergency Medicine, Optikov 54, Saint-Petersburg, Russian Federation, 197448
| | - Leonid Kolotilov
- Department of Anesthesiology, The Nikiforov Center of Emergency Medicine, Optikov 54, Saint-Petersburg, Russian Federation, 197448
| | - Sergei Parvanyan
- Department of Anesthesiology, The Nikiforov Center of Emergency Medicine, Optikov 54, Saint-Petersburg, Russian Federation, 197448
| | - Gagik Akopyan
- Department of Urology, Sechenov First Moscow State Medical University, Optikov 54, Saint-Petersburg, Russian Federation, 197448
| | - Sergei Petrov
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Lva Tolstogo 17, Saint-Petersburg, Russian Federation, 197342
| | - Courtney M Cottone
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Orange, CA, 92868, USA
| | - John Sung
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Orange, CA, 92868, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Orange, CA, 92868, USA.
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Qiu Y, Xu L, Jia Y. End-tidal carbon dioxide monitoring revealed severe complications during cardiothoracic surgery. Pediatr Investig 2019; 3:58-59. [PMID: 32851291 PMCID: PMC7331385 DOI: 10.1002/ped4.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/24/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION With the continuous progress being made in medicine and surgery, increasingly more advanced technology and monitoring equipment are being used in anesthesia, end-tidal carbon dioxide (PETCO 2) monitoring revealed serious complications of cardiothoracic surgery. CASE PRESENTATION A 3-year-old boy with a body weight of 15 kg presented with a >1-month history of a heart murmur. At the moment of arterial catheter ligation, the PETCO 2 decreased from 37 to 15 mmHg, while the blood pressure, heart rate, and airway resistance did not change significantly. After re-separation of the ligation catheter, the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus. CONCLUSION This case suggests that PETCO2 monitoring reflects the circulatory status and pulmonary blood flow.
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Affiliation(s)
- Yongsheng Qiu
- Department of AnesthesiologyChildren's Hospital Affiliated to Zhengzhou UniversityHenan Children's HospitalZhengzhou Children's HospitalZhengzhouHenanChina
| | - Lei Xu
- Department of AnesthesiologyChildren's Hospital Affiliated to Zhengzhou UniversityHenan Children's HospitalZhengzhou Children's HospitalZhengzhouHenanChina
| | - Yingping Jia
- Department of AnesthesiologyChildren's Hospital Affiliated to Zhengzhou UniversityHenan Children's HospitalZhengzhou Children's HospitalZhengzhouHenanChina
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Hyun SH, Ryew CC. Kinetic analysis of cardiac compression-force according to the level of information provision in the cardiopulmonary resuscitation. J Exerc Rehabil 2019; 15:170-174. [PMID: 30899754 PMCID: PMC6416517 DOI: 10.12965/jer.1938024.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Che-Cheong Ryew
- Corresponding author: Che-Cheong Ryew, https://orcid.org/0000-0001-9473-3990, Department of Kinesiology, College of Natural Science, Jeju National University, 102 Jejudaehak-ro, Jeju 63243, Korea, E-mail:
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Ruiz de Gauna S, Leturiondo M, Gutiérrez JJ, Ruiz JM, González-Otero DM, Russell JK, Daya M. Enhancement of capnogram waveform in the presence of chest compression artefact during cardiopulmonary resuscitation. Resuscitation 2018; 133:53-58. [PMID: 30278204 DOI: 10.1016/j.resuscitation.2018.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/17/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current resuscitation guidelines emphasize the use of waveform capnography to help guide rescuers during cardiopulmonary resuscitation (CPR). However, chest compressions often cause oscillations in the capnogram, impeding its reliable interpretation, either visual or automated. The aim of the study was to design an algorithm to enhance waveform capnography by suppressing the chest compression artefact. METHODS Monitor-defibrillator recordings from 202 patients in out-of-hospital cardiac arrest were analysed. Capnograms were classified according to the morphology of the artefact. Ventilations were annotated using the transthoracic impedance signal acquired through defibrillation pads. The suppression algorithm is designed to operate in real-time, locating distorted intervals and restoring the envelope of the capnogram. We evaluated the improvement in automated ventilation detection, estimation of ventilation rate, and detection of excessive ventilation rates (over-ventilation) using the capnograms before and after artefact suppression. RESULTS A total of 44 267 ventilations were annotated. After artefact suppression, sensitivity (Se) and positive predictive value (PPV) of the ventilation detector increased from 91.9/89.5% to 98.0/97.3% in the distorted episodes (83/202). Improvement was most noticeable for high-amplitude artefact, for which Se/PPV raised from 77.6/73.5% to 97.1/96.1%. Estimation of ventilation rate and detection of over-ventilation also upgraded. The suppression algorithm had minimal impact in non-distorted data. CONCLUSION Ventilation detection based on waveform capnography improved after chest compression artefact suppression. Moreover, the algorithm enhances the capnogram tracing, potentially improving its clinical interpretation during CPR. Prospective research in clinical settings is needed to understand the feasibility and utility of the method.
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Affiliation(s)
- Sofía Ruiz de Gauna
- Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain.
| | - Mikel Leturiondo
- Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain
| | - J Julio Gutiérrez
- Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain
| | - Jesus M Ruiz
- Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain
| | - Digna M González-Otero
- Department of Communications Engineering, University of the Basque Country, UPV/EHU, 48013 Bilbao, Spain
| | - James K Russell
- Department of Emergency Medicine, Oregon Health & Science University, OHSU, 97239-3098 Portland, OR, USA
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University, OHSU, 97239-3098 Portland, OR, USA
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Venkatesh H, Keating E. BET 1: Can the value of end tidal CO 2 prognosticate ROSC in patients coming into emergency department with an out-of-hospital cardiac arrest (OOHCA)? Emerg Med J 2018; 34:187-189. [PMID: 28232629 PMCID: PMC5502233 DOI: 10.1136/emermed-2017-206590.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hogen T, Cole SG, Drobatz KJ. Evaluation of end-tidal carbon dioxide as a predictor of return of spontaneous circulation in dogs and cats undergoing cardiopulmonary resuscitation. J Vet Emerg Crit Care (San Antonio) 2018; 28:398-407. [PMID: 30117723 DOI: 10.1111/vec.12755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/17/2016] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the partial pressure of end-tidal carbon dioxide (PetCO2 ) could predict return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) undergoing CPR. DESIGN Prospective observational study. SETTING Two private specialty referral hospitals. ANIMALS Thirty-five client-owned dogs and cats in CPA in which CPR was performed and pertinent data recorded on a purpose-made form. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS PetCO2 was recorded at 1-minute intervals during CPR. Hospital, animal, arrest, and outcome variables were also reported in the Utstein style where possible. Twelve animals (7 dogs and 5 cats) achieved ROSC; 4 of these (2 dogs and 2 cats) had sustained ROSC, of which 1 dog was discharged alive. Patients that achieved ROSC had significantly higher initial PetCO2 (P = 0.0083), peak PetCO2 (P < 0.0001), average PetCO2 (P < 0.0001), and ΔPetCO2 (difference between last and first recorded PetCO2 ; P = 0.0004) than patients not resuscitated. The PetCO2 accurately discriminated between ROSC and failure to achieve ROSC at minutes 3, 4, 5, 6, 7, and 8 of CPR with area under the receiver operating characteristic curve of 0.926, 0.967, 0.938, 0.933, 0.956, and 1.00, respectively. The optimal cutoff PetCO2 was 18 mm Hg (2.4 kPa), with a sensitivity of ≥80% and a specificity of ≥95% at minutes 3, 4, 5, 6, and 8, correctly classifying 91-100% of cases. CONCLUSIONS The results of this small study support previous recommendations to monitor PetCO2 during CPR and suggest that PetCO2 during CPR may be useful for determining the probability of ROSC. Absolute values and trends of PetCO2 may assist clinicians and owners in making decisions for pets with CPA.
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Affiliation(s)
- Talli Hogen
- Advanced Critical Care, Emergency and Specialty Services, Culver City, CA
| | - Steven G Cole
- Advanced Critical Care, Emergency and Specialty Services, Culver City, CA
| | - Kenneth J Drobatz
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA
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Gutiérrez JJ, Leturiondo M, Ruiz de Gauna S, Ruiz JM, Leturiondo LA, González-Otero DM, Zive D, Russell JK, Daya M. Enhancing ventilation detection during cardiopulmonary resuscitation by filtering chest compression artifact from the capnography waveform. PLoS One 2018; 13:e0201565. [PMID: 30071008 PMCID: PMC6072040 DOI: 10.1371/journal.pone.0201565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND During cardiopulmonary resuscitation (CPR), there is a high incidence of capnograms distorted by chest compression artifact. This phenomenon adversely affects the reliability of automated ventilation detection based on the analysis of the capnography waveform. This study explored the feasibility of several filtering techniques for suppressing the artifact to improve the accuracy of ventilation detection. MATERIALS AND METHODS We gathered a database of 232 out-of-hospital cardiac arrest defibrillator recordings containing concurrent capnograms, compression depth and transthoracic impedance signals. Capnograms were classified as non-distorted or distorted by chest compression artifact. All chest compression and ventilation instances were also annotated. Three filtering techniques were explored: a fixed-coefficient (FC) filter, an open-loop (OL) adaptive filter, and a closed-loop (CL) adaptive filter. The improvement in ventilation detection was assessed by comparing the performance of a capnogram-based ventilation detection algorithm with original and filtered capnograms. RESULTS Sensitivity and positive predictive value of the ventilation algorithm improved from 91.9%/89.5% to 97.7%/96.5% (FC filter), 97.6%/96.7% (OL), and 97.0%/97.1% (CL) for the distorted capnograms (42% of the whole set). The highest improvement was obtained for the artifact named type III, for which performance improved from 77.8%/74.5% to values above 95.5%/94.5%. In addition, errors in the measurement of ventilation rate decreased and accuracy in the detection of over-ventilation increased with filtered capnograms. CONCLUSIONS Capnogram-based ventilation detection during CPR was enhanced after suppressing the artifact caused by chest compressions. All filtering approaches performed similarly, so the simplicity of fixed-coefficient filters would take advantage for a practical implementation.
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Affiliation(s)
- Jose Julio Gutiérrez
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - Mikel Leturiondo
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
- * E-mail:
| | - Sofía Ruiz de Gauna
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - Jesus María Ruiz
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - Luis Alberto Leturiondo
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - Digna María González-Otero
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), Bilbao, Bizkaia, Spain
| | - Dana Zive
- Department of Emergency Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, United States of America
| | - James Knox Russell
- Department of Emergency Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, United States of America
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, United States of America
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Leturiondo M, Ruiz de Gauna S, Ruiz JM, Julio Gutiérrez J, Leturiondo LA, González-Otero DM, Russell JK, Zive D, Daya M. Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation. Resuscitation 2018; 124:63-68. [DOI: 10.1016/j.resuscitation.2017.12.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022]
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Jansen TD, Stutzman S, Yu C, Parry D, Olson DM. Pilot Study of Educational Gaming to Improve Adherence to an End-Tidal Carbon Dioxide Monitoring Protocol. J Contin Educ Nurs 2018; 49:79-83. [PMID: 29381171 DOI: 10.3928/00220124-20180116-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND End-tidal carbon dioxide (ETCO2) monitoring is an important part of patient care. Understanding and interpreting ETCO2 wavelengths can be a challenge. This pilot study explored the efficacy of a novel approach to educating clinicians on ETCO2 monitoring via game theory. METHOD A video game application for ETCO2 monitoring was developed. Clinicians were encouraged to play the game over a 3-month period. Compliance with the ETCO2 protocol was compared in a random selection of patients admitted before, during, and after the intervention. RESULTS Thirty-eight clinicians completed the preand posttest, with a significant difference in test scores (p = .03). The intervention was associated with higher adherence to the ETCO2 protocol before and after the intervention (p < .05). CONCLUSION The availability of new technologies has created opportunities to develop new approaches to educate clinicians. This study showed that the use of a game improved adherence to the ETCO2 protocol. J Contin Educ Nurs. 2018;49(2):79-83.
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Paiva EF, Paxton JH, O’Neil BJ. The use of end-tidal carbon dioxide (ETCO 2 ) measurement to guide management of cardiac arrest: A systematic review. Resuscitation 2018; 123:1-7. [DOI: 10.1016/j.resuscitation.2017.12.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/26/2017] [Accepted: 12/03/2017] [Indexed: 01/05/2023]
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Dorbad M, Kass A, Marvin M. Hemodynamically Directed Two-Person Chest Compressions: A Case Report. ACTA ACUST UNITED AC 2017; 9:286-288. [PMID: 28691985 DOI: 10.1213/xaa.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiopulmonary resuscitation has a low success rate both in and out of the hospital setting. Return of spontaneous circulation, however, is considerably higher for intraoperative cardiac arrests. Chest compressions remain of utmost importance. Optimal chest compression depth is believed to be greater than 5 cm. However, this depth is often not achieved. We describe a case in which the adequacy of chest compressions, based on hemodynamic monitoring, was achieved with 2 persons simultaneously providing a compressive force. This hemodynamic-directed care resulted in return of spontaneous circulation on 2 separate occasions.
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Affiliation(s)
- Michael Dorbad
- From the *Department of Anesthesiology, Geisinger Medical Center, Danville, Pennsylvania; †Department of Internal Medicine, Eastern Virginia Medical Campus, Norfolk, Virginia; and ‡Department of Transplantation and Liver Surgery, Geisinger Medical Center, Danville, Pennsylvania
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Zhang Z. Echocardiography for patients undergoing extracorporeal cardiopulmonary resuscitation: a primer for intensive care physicians. J Intensive Care 2017; 5:15. [PMID: 28168038 PMCID: PMC5288871 DOI: 10.1186/s40560-017-0211-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/26/2017] [Indexed: 02/07/2023] Open
Abstract
Echocardiography is an invaluable tool in the management of patients with extracorporeal cardiopulmonary resuscitation (ECPR) and subsequent extracorporeal membrane oxygenation (ECMO) support and weaning. At the very beginning, echocardiography can identify the etiology of cardiac arrest, such as massive pulmonary embolism and cardiac tamponade. Eliminating these culprits saves life and may avoid the initiation of extracorporeal cardiopulmonary resuscitation. If the underlying causes are not identified or intrinsic to the heart (e.g., such as those caused by cardiomyopathy and myocarditis), conventional cardiopulmonary resuscitation (CCPR) will continue to maintain cardiac output. The quality of CCPR can be monitored, and if cardiac output cannot be maintained, early institution of extracorporeal cardiopulmonary resuscitation may be reasonable. Cannulation is sometimes challenging for extracorporeal cardiopulmonary resuscitation patients. Fortunately, with the help of ultrasonography procedures including localization of vessels, selecting a cannula of appropriate size and confirmation of catheter tip may become easy under sophisticated hand. Monitoring of cardiac function and complications during extracorporeal membrane oxygenation support can be done with echocardiography. However, the cardiac parameters should be interpreted with understanding of hemodynamic configuration of extracorporeal membrane oxygenation. Thrombus and blood stasis can be identified with ultrasound, which may prompt mechanical and pharmacological interventions. The final step is extracorporeal membrane oxygenation weaning. A number of studies investigated the accuracy of some echocardiographic parameters in predicting success rate and demonstrated promising results. Parameters and threshold for successful weaning include aortic VTI ≥ 10 cm, LVEF > 20-25%, and lateral mitral annulus peak systolic velocity >6 cm/s. However, the effectiveness of echocardiography in ECPR patients cannot be determined in observational studies and requires randomized controlled trials in the future. The contents in this review are well known to echocardiography specialists; thus, it should be used as an educational material for emergency or intensive care physicians. There is a trend that focused echocardiography is performed by intensivists and emergency physicians.
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Affiliation(s)
- Zhongheng Zhang
- 0000 0004 1759 700Xgrid.13402.34Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
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Cournoyer A, Iseppon M, Chauny JM, Denault A, Cossette S, Notebaert É. Near-infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta-analysis. Acad Emerg Med 2016; 23:851-62. [PMID: 27028004 DOI: 10.1111/acem.12980] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/05/2016] [Accepted: 03/28/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA) because of its ability to give measures in low-blood-flow situations. The aim of this study was to assess the evidence regarding the association between the types of NIRS measurements (mean, initial, and highest values) and resuscitation outcomes (return of spontaneous circulation [ROSC], survival to discharge, and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation. METHODS This review was registered (Prospero CRD42015017380) and is reported as per the PRISMA guidelines. Medline, Embase, and CENTRAL were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had NIRS monitoring during CA were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (SMD). RESULTS Twenty nonrandomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2,436 patients. We found a stronger association between ROSC and mean NIRS values (SMD = 1.33; 95% confidence interval [CI] = 0.92 to 1.74) than between ROSC and initial NIRS measurements (SMD = 0.51; 95% CI = 0.23 to 0.78). There was too much heterogeneity among the highest NIRS measurements group to perform meta-analysis. Only two of the 75 patients who experienced ROSC had a mean NIRS saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean NIRS values than their counterparts (SMD = 1.63; 95% CI = 1.34 to 1.92; and SMD = 2.12; 95% CI = 1.14 to 3.10). CONCLUSIONS Patients with good resuscitation outcomes have significantly higher NIRS saturations during resuscitation than their counterparts. The types of NIRS measurements during resuscitation influenced the association between ROSC and NIRS saturation. Prolonged failure to obtain a NIRS saturation higher than 30% may be included in a multimodal approach to the decision of terminating resuscitation efforts (Class IIb, Level of Evidence C-Limited Data).
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Affiliation(s)
| | | | - Jean-Marc Chauny
- Université de Montréal; Montréal Québec
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec
| | - André Denault
- Université de Montréal; Montréal Québec
- Montreal Heart Institute; Montréal Québec
- Centre Hospitalier de l'Université de Montréal; Montréal Québec
| | - Sylvie Cossette
- Université de Montréal; Montréal Québec
- Montreal Heart Institute; Montréal Québec
| | - Éric Notebaert
- Université de Montréal; Montréal Québec
- Hôpital du Sacré-Cœur de Montréal; Montréal Québec
- Cité de la Santé de Laval; Montréal Québec Canada
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