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Chu SE, Huang CY, Cheng CY, Chan CH, Chen HA, Chang CH, Tsai KC, Chiu KM, Ma MHM, Chiang WC, Sun JT. Cardiopulmonary Resuscitation Without Aortic Valve Compression Increases the Chances of Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Prospective Observational Cohort Study. Crit Care Med 2024; 52:1367-1379. [PMID: 38780398 DOI: 10.1097/ccm.0000000000006336] [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: 05/25/2024]
Abstract
OBJECTIVES Following current cardiopulmonary resuscitation (CPR) guidelines, which recommend chest compressions at "the center of the chest," ~50% of patients experiencing out-of-hospital cardiac arrest (OHCA) undergo aortic valve (AV) compression, obstructing blood flow. We used resuscitative transesophageal echocardiography (TEE) to elucidate the impact of uncompressed vs. compressed AV on outcomes of adult patients experiencing OHCA. DESIGN Prospective observational cohort study. SETTING Single center. PATIENTS This study included adult OHCA patients undergoing resuscitative TEE in the emergency department. Patients were categorized into AV uncompressed or AV compressed groups based on TEE findings. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was sustained return of spontaneous circulation (ROSC). The secondary outcomes included end-tidal co2 (Et co2 ) during CPR, any ROSC, survival to ICU and hospital discharge, post-resuscitation withdrawal, and favorable neurologic outcomes at discharge. Additional analyses on intra-arrest arterial blood pressure (ABP) were also conducted. The sample size was pre-estimated at 37 patients/group. From October 2020 to January 2023, 76 patients were enrolled, 39 and 37 in the AV uncompressed and AV compressed groups, respectively. Intergroup baseline characteristics were similar. Compared with the AV compressed group, the AV uncompressed group had a higher probability of sustained ROSC (53.8% vs. 24.3%; adjusted odds ratio [aOR], 4.72; p = 0.010), any ROSC (56.4% vs. 32.4%; aOR, 3.30; p = 0.033), and survival to ICU (33.3% vs. 8.1%; aOR, 6.74; p = 0.010), and recorded higher initial diastolic ABP (33.4 vs. 11.5 mm Hg; p = 0.002) and a larger proportion achieving diastolic ABP greater than 20 mm Hg during CPR (93.8% vs. 33.3%; p < 0.001). The Et co2 , post-resuscitation withdrawal, and survival to discharge revealed no significant intergroup differences. No patients were discharged with favorable neurologic outcomes. Uncompressed AV seemed critical for sustained ROSC across all subgroups. CONCLUSIONS Absence of AV compression during OHCA resuscitation is associated with an increased chance of ROSC and survival to ICU. However, its effect on long-term outcomes remains unclear.
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Affiliation(s)
- Sheng-En Chu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chiao-Yin Cheng
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hsiang Chan
- Department of Geography, National Taiwan Normal University, Taipei, Taiwan
| | - Hsuan-An Chen
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chin-Ho Chang
- Statistical Consulting Unit, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuang-Chau Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliu City, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Jenten Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan
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Brainard BM, Lane SL, Burkitt-Creedon JM, Boller M, Fletcher DJ, Crews M, Fausak ED. 2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR. J Vet Emerg Crit Care (San Antonio) 2024; 34 Suppl 1:76-103. [PMID: 38924672 DOI: 10.1111/vec.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps. DESIGN Standardized, systematic evaluation of literature pertinent to peri-CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS Thirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end-tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion. CONCLUSIONS The Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re-arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra-arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome-relevant interventions.
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Affiliation(s)
- Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Selena L Lane
- Veterinary Emergency Group, Cary, North Carolina, USA
| | - Jamie M Burkitt-Creedon
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Molly Crews
- Department of Small animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Erik D Fausak
- University Library, University of California, Davis, Davis, California, USA
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Utsumi S, Nishikmi M, Ohshimo S, Shime N. Differences in Pathophysiology and Treatment Efficacy Based on Heterogeneous Out-of-Hospital Cardiac Arrest. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:510. [PMID: 38541236 PMCID: PMC10972304 DOI: 10.3390/medicina60030510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 06/15/2024]
Abstract
Out-of-hospital cardiac arrest (OHCA) is heterogeneous in terms of etiology and severity. Owing to this heterogeneity, differences in outcome and treatment efficacy have been reported from case to case; however, few reviews have focused on the heterogeneity of OHCA. We conducted a literature review to identify differences in the prognosis and treatment efficacy in terms of CA-related waveforms (shockable or non-shockable), age (adult or pediatric), and post-CA syndrome severity and to determine the preferred treatment for patients with OHCA to improve outcomes.
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Affiliation(s)
| | - Mitsuaki Nishikmi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.U.); (S.O.)
| | | | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.U.); (S.O.)
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Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B. The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2023; 28:478-484. [PMID: 37751228 PMCID: PMC10963336 DOI: 10.1080/10903127.2023.2262566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE End tidal carbon dioxide (ETCO2) is often used to assess ventilation and perfusion during cardiac arrest resuscitation. However, few data exist evaluating the relationship between ETCO2 values and mortality in the context of contemporary resuscitation practices. We aimed to explore the association between ETCO2 and mortality following out-of-hospital cardiac arrest (OHCA). METHODS We used the 2018-2021 ESO annual datasets to query all non-traumatic OHCA patients with attempted resuscitation. Patients with documented DNR/POLST, EMS-witnessed arrest, ROSC after bystander CPR only, or < 2 documented ETCO2 values were excluded. The lowest and highest ETCO2 values recorded during the total prehospital interval, in addition to the pre- and post-ROSC intervals for resuscitated patients, were calculated. Multivariable logistic regression models adjusted for age, sex, initial rhythm, witnessed status, bystander CPR, etiology, OHCA location, sodium bicarbonate administration, number of milligrams of epinephrine administered, and response interval were used to evaluate the association between measures of ETCO2 and mortality. RESULTS Hospital outcome data were available for 14,122 patients, and 2,209 (15.6%) were classified as surviving to discharge. Compared to patients with maximum prehospital ETCO2 values of 30-40 mmHg, odds of mortality were increased for patients with maximum prehospital ETCO2 values of <20 mmHg (aOR: 3.5 [2.1, 5,9]), 20-29 mmHg (aOR: 1.5 [1.1, 2.1]), and >50 mmHg (aOR: 1.5 [1.2, 1.8]). After 20 minutes of ETCO2 monitoring, <12% of patients had ETCO2 values <10 mmHg. This cutpoint was 96.7% specific and 6.9% sensitive for mortality. CONCLUSION In this dataset, both high and low ETCO2 values were associated with increased mortality. Contemporary resuscitation practices may make low ETCO2 values uncommon, and field termination decision algorithms should not use ETCO2 values in isolation.
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Affiliation(s)
- Tanner Smida
- West Virginia University Department of Emergency Medicine, Division of Prehospital Medicine, Morgantown, WV, USA
| | - James J. Menegazzi
- University of Pittsburgh Department of Emergency Medicine, Pittsburgh, PA, USA
| | | | - David D. Salcido
- University of Pittsburgh Department of Emergency Medicine, Pittsburgh, PA, USA
| | - James Bardes
- West Virginia University Department of Surgery, Morgantown, WV, USA
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de la Mata Navazo S, Manrique G, Fernández SN, Pérez G, Butragueño-Laiseca L, García M, Slöcker M, González R, Herrera L, Mencía S, Del Castillo J, Solana MJ, Sanz D, Cieza R, López J, Rodríguez Martínez A, Santiago MJ, Urbano J, López-Herce J. Volumetric capnography and return of spontaneous circulation in an experimental model of pediatric asphyxial cardiac arrest. Sci Rep 2023; 13:12247. [PMID: 37507472 PMCID: PMC10382559 DOI: 10.1038/s41598-023-37827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
A secondary analysis of a randomized study was performed to study the relationship between volumetric capnography (VCAP) and arterial CO2 partial pressure (PCO2) during cardiopulmonary resuscitation (CPR) and to analyze the ability of these parameters to predict the return of spontaneous circulation (ROSC) in a pediatric animal model of asphyxial cardiac arrest (CA). Asphyxial CA was induced by sedation, muscle relaxation and extubation. CPR was started 2 min after CA occurred. Airway management was performed with early endotracheal intubation or bag-mask ventilation, according to randomization group. CPR was continued until ROSC or 24 min of resuscitation. End-tidal carbon dioxide (EtCO2), CO2 production (VCO2), and EtCO2/VCO2/kg ratio were continuously recorded. Seventy-nine piglets were included, 26 (32.9%) of whom achieved ROSC. EtCO2 was the best predictor of ROSC (AUC 0.72, p < 0.01 and optimal cutoff point of 21.6 mmHg). No statistical differences were obtained regarding VCO2, VCO2/kg and EtCO2/VCO2/kg ratios. VCO2 and VCO2/kg showed an inverse correlation with PCO2, with a higher correlation coefficient as resuscitation progressed. EtCO2 also had an inverse correlation with PCO2 from minute 18 to 24 of resuscitation. Our findings suggest that EtCO2 is the best VCAP-derived parameter for predicting ROSC. EtCO2 and VCO2 showed an inverse correlation with PCO2. Therefore, these parameters are not adequate to measure ventilation during CPR.
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Affiliation(s)
- Sara de la Mata Navazo
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Gema Manrique
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain.
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain.
| | - Sarah Nicole Fernández
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Gema Pérez
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Laura Butragueño-Laiseca
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Miriam García
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María Slöcker
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Rafael González
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laura Herrera
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Santiago Mencía
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jimena Del Castillo
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María José Solana
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Débora Sanz
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Raquel Cieza
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Jorge López
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Alicia Rodríguez Martínez
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - María José Santiago
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Urbano
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Department, Gregorio Marañón University Hospital, Dr Castelo 47, 28009, Madrid, Spain
- Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network (RICORS) RD21/0012/0011, Carlos III Health Institute, Madrid, Spain
- Maternal and Child Public Health Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
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End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients. Resuscitation 2022; 181:197-207. [PMID: 36162612 DOI: 10.1016/j.resuscitation.2022.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
AIM To evaluate whether end-tidal carbon dioxide (ETCO2) value at intubation and its early increase (10 min) after intubation predict both the survival to hospital admission and the survival at hospital discharge, including good neurological outcome (CPC 1-2), in patients with out-of-hospital cardiac arrest (OHCA). METHODS All consecutive OHCA patients of any etiology between 2015 and 2018 in Pavia Province (Italy) and Ticino Region (Switzerland) were considered. Patients died before ambulance arrival, with a "do-not-resuscitate" order, without ETCO2 value or with incomplete data were excluded. RESULTS The study population consisted of 668 patients. An ETCO2 value at intubation > 20 mmHg and its increase 10 min after intubation were independent predictors (after correction for known predictors of OHCA outcome) of survival to hospital admission and survival at hospital discharge. Relative to hospital discharge with good neurological outcome, ETCO2 at intubation and its 10-min change were confirmed predictors both individually and in a bivariable analysis (OR 1.83, 95 %CI 1.02-3.3; p = 0.04 and OR 3.9, 95 %CI 1.97-7.74; p < 0.001, respectively). This was confirmed also when accounting for gender, age, etiology and location. After further adjustment for bystander and CPR status, presenting rhythm and EMS arrival time, the ETCO2 change remained an independent predictor. CONCLUSIONS ETCO2 value > 20 mmHg at intubation and its increase during resuscitation improve the prediction of survival at hospital discharge with good neurological outcome of OHCA patients. ETCO2 increase during resuscitation is a more powerful predictor than ETCO2 at intubation. A larger prospective study to confirm this finding appears warranted.
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Wang CH, Lu TC, Tay J, Wu CY, Wu MC, Chong KM, Chou EH, Tsai CL, Huang CH, Huei-Ming Ma M, Chen WJ. Association between Trajectories of End-tidal Carbon Dioxide and Return of Spontaneous Circulation among Emergency Department Patients with Out-of-hospital Cardiac Arrest. Resuscitation 2022; 177:28-37. [PMID: 35750286 DOI: 10.1016/j.resuscitation.2022.06.013] [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: 04/26/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to identify distinct trajectories of end-tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) and to investigate the association between EtCO2 trajectories and OHCA outcomes. METHODS This was a secondary analysis of a prospectively collected database on adult patients with OHCA who had been resuscitated in the emergency department of a tertiary medical center between 2015 and 2020. The primary outcome was the return of spontaneous circulation (ROSC). Group-based trajectory modelling was used to identify the EtCO2 trajectories. Multivariable logistic regression analysis was performed to evaluate the association between EtCO2 trajectories and ROSC. The predictive performance of the EtCO2 trajectories was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS The study comprised 655 patients with OHCA. In the primary analysis, three distinct EtCO2 trajectories, including 10-mmHg, 30-mmHg, and 50-mmHg trajectories, were identified. Compared with the 10-mmHg trajectory, both 30-mmHg (odds ratio [OR]: 4.66, 95% confidence interval [CI]: 3.15-6.90) and 50-mmHg (OR: 7.58, 95% CI: 4.30-13.35) trajectories were associated with a higher likelihood of ROSC. In a sensitivity analysis of excluding EtCO2 measured before tracheal intubation or after sodium bicarbonate administration, the predictive ability of the identified EtCO2 trajectories remained. As a single predictor of ROSC, EtCO2 trajectories had an acceptable discriminative performance (AUC: 0.69, 95% CI: 0.66-0.73). CONCLUSION Three distinct EtCO2 trajectories during cardiopulmonary resuscitation were identified and significantly associated with outcomes. Early identification of these EtCO2 trajectories could potentially guide the ongoing resuscitation efforts.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Chien Lu
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Joyce Tay
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Eric H Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX, USA; Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Chu-Lin Tsai
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Luo L, Zhang X, Xiang T, Dai H, Zhang J, Zhuo G, Sun Y, Deng X, Zhang W, Du M. Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department. J Int Med Res 2021; 49:3000605211025368. [PMID: 34182817 PMCID: PMC8246509 DOI: 10.1177/03000605211025368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the outcomes of patients with non-traumatic cardiac arrest (CA) who received early versus late mechanical cardiopulmonary resuscitation (CPR) with the Lund University Cardiac Assist System (LUCAS) device in the emergency department (ED). Methods This was a retrospective observational study in the ED of a single medical center performed from May 2018 to December 2019; 68 patients with CA were eligible. We grouped the patients according to the time to initiating LUCAS use after CA into an early group (≤4 minutes) and late group (>4 minutes). Results The rate of return of spontaneous circulation (ROSC) was higher in the early group vs the late group (69.2% vs 52.4%, respectively). The 4-hour survival rate was significantly higher in the early group vs the late group (83.3% vs 45.5%, respectively), and CPR duration was significantly shorter in the early group (23.3 ± 12.5 vs 31.1 ± 14.8 minutes, respectively). Conclusion Early mechanical CPR can improve the success of achieving ROSC and the 4-hour survival rate in patients with non-traumatic CA in the ED, considering that more benefits were observed in patients who received early vs late LUCAS device therapy.
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Affiliation(s)
- Li Luo
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - XiaoDong Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Tao Xiang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Hang Dai
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - JiMei Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - GuangYing Zhuo
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - YuFang Sun
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - XiaoJun Deng
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Wei Zhang
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Ming Du
- Emergency Department, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, PR China
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9
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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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10
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Azeli Y, Bardají A, Barbería E, Lopez-Madrid V, Bladé-Creixenti J, Fernández-Sender L, Bonet G, Rica E, Álvarez S, Fernández A, Axelsson C, Jiménez-Herrera MF. Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial. Crit Care 2021; 25:176. [PMID: 34034775 PMCID: PMC8152146 DOI: 10.1186/s13054-021-03593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA). METHODS We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors. RESULTS In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60-82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7-1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8-3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909-1500) vs 1239 mg (IQR 900-1507), p = 0.82] or brain weight [1352 mg (IQR 1227-1457) vs 1380 mg (IQR 1255-1470), p = 0.43] among the 106 autopsies performed. CONCLUSION In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197 .
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Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain.
- Emergency Department, Sant Joan University Hospital, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
| | - Alfredo Bardají
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Eneko Barbería
- Universitat Rovira i Virgili, Tarragona, Spain
- Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain
| | | | | | | | - Gil Bonet
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Elena Rica
- Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Susana Álvarez
- Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Alberto Fernández
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Spain
| | - Christer Axelsson
- Center of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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11
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Morgan RW, Kirschen MP, Kilbaugh TJ, Sutton RM, Topjian AA. Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States: A Review. JAMA Pediatr 2021; 175:293-302. [PMID: 33226408 PMCID: PMC8787313 DOI: 10.1001/jamapediatrics.2020.5039] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Pediatric in-hospital cardiac arrest (IHCA) occurs frequently and is associated with high morbidity and mortality. The objective of this narrative review is to summarize the current knowledge and recommendations regarding pediatric IHCA and cardiopulmonary resuscitation (CPR). OBSERVATIONS Each year, more than 15 000 children receive CPR for cardiac arrest during hospitalization in the United States. As many as 80% to 90% survive the event, but most patients do not survive to hospital discharge. Most IHCAs occur in intensive care units and other monitored settings and are associated with respiratory failure or shock. Bradycardia with poor perfusion is the initial rhythm in half of CPR events, and only about 10% of events have an initial shockable rhythm. Pre-cardiac arrest systems focus on identifying at-risk patients and ensuring that they are in monitored settings. Important components of CPR include high-quality chest compressions, timely defibrillation when indicated, appropriate ventilation and airway management, administration of epinephrine to increase coronary perfusion pressure, and treatment of the underlying cause of cardiac arrest. Extracorporeal CPR and measurement of physiological parameters are evolving areas in improving outcomes. Structured post-cardiac arrest care focused on targeted temperature management, optimization of hemodynamics, and careful intensive care unit management is associated with improved survival and neurological outcomes. CONCLUSIONS AND RELEVANCE Pediatric IHCA occurs frequently and has a high mortality rate. Early identification of risk, prevention, delivery of high-quality CPR, and post-cardiac arrest care can maximize the chances of achieving favorable outcomes. More research in this field is warranted.
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Affiliation(s)
- Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Matthew P. Kirschen
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert M. Sutton
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexis A. Topjian
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Javaudin F, Her S, Le Bastard Q, De Carvalho H, Le Conte P, Baert V, Hubert H, Montassier E, Lascarrou JB, Leclère B. Maximum Value of End-Tidal Carbon Dioxide Concentrations during Resuscitation as an Indicator of Return of Spontaneous Circulation in out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2019; 24:478-484. [PMID: 31613696 DOI: 10.1080/10903127.2019.1680782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The end-tidal carbon dioxide (ETCO2) concentration during resuscitation (CPR) of an out-of-hospital cardiac arrest (OHCA) has an increasingly well-known prognostic value. Nevertheless, few studies have investigated its maximum value in different etiologies. Methods: It was a retrospective, observational, multicentre study from the French OHCA Registry. All adult OHCA with a known maximum value of ETCO2 during CPR were included. The primary end-point was to determine the area under the receiver operating characteristic curve (AUROC) of the maximum value of ETCO2 during resuscitation for the return of spontaneous circulation (ROSC). Results: Of the 53,048 eligible subjects from 2011 to 2018, ETCO2 was known in 32,249 subjects (61%). Among them, there were 9.2% of traumatic OHCA, 37.7% of suspected cardiac etiology and 16.4% of suspected respiratory etiology. The AUROC of maximum value of ETCO2 during CPR to achieve ROSC was 0.887 95CI [0.875-0.898] in traumatic OHCA, 0.772 95CI [0.765-0.780] in suspected cardiac etiology and 0.802 95CI [0.791-0.812] in suspected respiratory etiology. The threshold with no survivors at d-30 was <10 mmHg for traumatic etiologies and <6 mmHg for suspected cardiac and respiratory causes. The probability of ROSC increased with the value of ETCO2 in the 3 etiologies studied. Conclusions: The maximum value of ETCO2 during OHCA resuscitation was strongly associated with ROSC, especially in the case of a traumatic cause. This suggests that a single elevated ETCO2 value, regardless of time, could help to predict the outcome.
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13
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Phenotyping Cardiac Arrest: Bench and Bedside Characterization of Brain and Heart Injury Based on Etiology. Crit Care Med 2019. [PMID: 29533310 DOI: 10.1097/ccm.0000000000003070] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Cardiac arrest etiology may be an important source of between-patient heterogeneity, but the impact of etiology on organ injury is unknown. We tested the hypothesis that asphyxial cardiac arrest results in greater neurologic injury than cardiac etiology cardiac arrest (ventricular fibrillation cardiac arrest), whereas ventricular fibrillation cardiac arrest results in greater cardiovascular dysfunction after return of spontaneous circulation. DESIGN Prospective observational human and randomized animal study. SETTING University laboratory and ICUs. PATIENTS Five-hundred forty-three cardiac arrest patients admitted to ICU. SUBJECTS Seventy-five male Sprague-Dawley rats. INTERVENTIONS We examined neurologic and cardiovascular injury in Isoflurane-anesthetized rat cardiac arrest models matched by ischemic time. Hemodynamic and neurologic outcomes were assessed after 5 minutes no flow asphyxial cardiac arrest or ventricular fibrillation cardiac arrest. Comparison was made to injury patterns observed after human asphyxial cardiac arrest or ventricular fibrillation cardiac arrest. MEASUREMENTS AND MAIN RESULTS In rats, cardiac output (20 ± 10 vs 45 ± 9 mL/min) and pH were lower and lactate higher (9.5 ± 1.0 vs 6.4 ± 1.3 mmol/L) after return of spontaneous circulation from ventricular fibrillation cardiac arrest versus asphyxial cardiac arrest (all p < 0.01). Asphyxial cardiac arrest resulted in greater early neurologic deficits, 7-day neuronal loss, and reduced freezing time (memory) after conditioned fear (all p < 0.05). Brain antioxidant reserves were more depleted following asphyxial cardiac arrest. In adjusted analyses, human ventricular fibrillation cardiac arrest was associated with greater cardiovascular injury based on peak troponin (7.8 ng/mL [0.8-57 ng/mL] vs 0.3 ng/mL [0.0-1.5 ng/mL]) and ejection fraction by echocardiography (20% vs 55%; all p < 0.0001), whereas asphyxial cardiac arrest was associated with worse early neurologic injury and poor functional outcome at hospital discharge (n = 46 [18%] vs 102 [44%]; p < 0.0001). Most ventricular fibrillation cardiac arrest deaths (54%) were the result of cardiovascular instability, whereas most asphyxial cardiac arrest deaths (75%) resulted from neurologic injury (p < 0.0001). CONCLUSIONS In transcending rat and human studies, we find a consistent phenotype of heart and brain injury after cardiac arrest based on etiology: ventricular fibrillation cardiac arrest produces worse cardiovascular dysfunction, whereas asphyxial cardiac arrest produces worsened neurologic injury associated with greater oxidative stress.
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14
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Poppe M, Stratil P, Clodi C, Schriefl C, Nürnberger A, Magnet I, Warenits AM, Hubner P, Lobmeyr E, Schober A, Zajicek A, Testori C. Initial end-tidal carbon dioxide as a predictive factor for return of spontaneous circulation in nonshockable out-of-hospital cardiac arrest patients: A retrospective observational study. Eur J Anaesthesiol 2019; 36:524-530. [PMID: 31742569 DOI: 10.1097/eja.0000000000000999] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early outcome prediction in out-of-hospital cardiac arrest is still a challenge. End-tidal carbon dioxide (ETCO2) has been shown to be a reliable parameter to reflect the quality of cardiopulmonary resuscitation and the chance of return of spontaneous circulation (ROSC). OBJECTIVES This study assessed the validity of early capnography as a predictive factor for ROSC and survival in out-of-hospital cardiac arrest victims with an underlying nonshockable rhythm. DESIGN Retrospective observational study. SETTING/PATIENTS During a 2-year observational period, data from 2223 out-of-hospital cardiac arrest victims within the city of Vienna were analysed. The focus was on the following patients: age more than 18 years, an underlying nonshockable rhythm, and advanced airway management within the first 15 min of advanced life support with subsequent capnography. INTERVENTION No specific intervention was set in this observational study. MAIN OUTCOME MEASURES The first measured ETCO2, assessed immediately after placement of an advanced airway, was used for further analysis. The primary outcome was defined as sustained ROSC, and the secondary outcome was 30-day survival. RESULTS A total of 526 patients met the inclusion criteria. These were stratified into three groups according to initial ETCO2 values (<20, 20 to 45, >45 mmHg). Baseline data and resuscitation factors were similar among all groups. The odds of sustained ROSC and survival were significantly higher for patients presenting with higher values of initial ETCO2 (>45 mmHg): 3.59 [95% CI, 2.19 to 5.85] P = 0.001 and 5.02 [95% CI, 2.25 to 11.23] P = 0.001, respectively. On the contrary ETCO2 levels less than 20 mmHg were associated with significantly poorer outcomes. CONCLUSION Patients with a nonshockable out-of-hospital cardiac arrest who presented with higher values of initial ETCO2 had an increased chance of sustained ROSC and survival. This finding could help decision making as regards continuation of resuscitation efforts.
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15
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Stine CN, Koch J, Brown LS, Chalak L, Kapadia V, Wyckoff MH. Quantitative end-tidal CO 2 can predict increase in heart rate during infant cardiopulmonary resuscitation. Heliyon 2019; 5:e01871. [PMID: 31245640 PMCID: PMC6581839 DOI: 10.1016/j.heliyon.2019.e01871] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
Aim To determine the end-tidal CO2 (ETCO2) value that predicts a HR > 60 beats per minute (bpm) with the best sensitivity and specificity during neonatal/infant cardiopulmonary resuscitation (CPR) defined as chest compressions ± epinephrine in neonates/infants admitted to a CVICU/PICU. Methods This was a retrospective cohort study from 1/1/08 to 12/31/12 of all infants ≤6 month of age who received CPR and had ETCO2 documented during serial resuscitations in the pediatric (PICU) or pediatric cardiovascular intensive care units (CVICU) of Children's Medical Center of Dallas. A receiver operator characteristic (ROC) curve was generated to determine the ETCO2 cut-off with the best sensitivity and specificity for predicting HR > 60 bpm. Each ETCO2 value was correlated to the infant's HR at that specific time. Results CPR was provided for 165 infants of which 49 infants had quantitative ETCO2 documented so only these infants were included. The majority were in the CVICU (81%) and intubated (84%). Mean gestational age was 36 ± 3 weeks and median age (interquartile range) at time of CPR was 30 (16-96) days. An ETCO2 between 17 and 18 mmHg correlated with the highest sensitivity and specificity for return of a HR > 60 bpm. Area under the curve for the ROC is 0.835. Conclusions This study provides critical clinical information regarding correlation between ETCO2 values and an adequate rise in heart rate in neonates and young infants during CPR. Quantitative ETCO2 monitoring allows CPR to progress uninterrupted without need to pause to check heart rate every 60 seconds until the critical ETCO2 threshold is reached. Quantitative ETCO2 monitoring as an adjunct to cardiac monitoring during infant CPR might enhance perfusion and improve outcomes.
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Affiliation(s)
| | - Josh Koch
- Division of Cardiac Critical Care, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - L. Steven Brown
- Department of Health System Research, Parkland Memorial Hospital, Dallas, TX, USA
| | - Lina Chalak
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal Kapadia
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myra H. Wyckoff
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Physiology-directed cardiopulmonary resuscitation: advances in precision monitoring during cardiac arrest. Curr Opin Crit Care 2019; 24:143-150. [PMID: 29629927 DOI: 10.1097/mcc.0000000000000499] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review the recent advances in physiologic monitoring during cardiac arrest and offer an evidence-based framework for prioritizing physiologic targets during cardiopulmonary resuscitation (CPR). RECENT FINDINGS Current CPR guidelines recommend a uniform approach for all patients in cardiac arrest, but newer data support a precision strategy that uses the individual patient's physiology to guide resuscitation. Coronary perfusion pressure and arterial DBP are associated with survival outcomes in recent animal and human studies. End-tidal carbon dioxide is a reasonable noninvasive alternative, but may be inferior to invasive hemodynamic endpoints. Cerebral oximetry and cardiac ultrasound are emerging physiologic indicators of CPR effectiveness. SUMMARY Physiologic monitoring can and should be used to deliver precision CPR whenever possible and may improve outcomes after cardiac arrest.
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Park SH, Lim YD, Jung YH, Jeung KW. Relationship between hemodynamic parameters and severity of ischemia-induced left ventricular wall thickening during cardiopulmonary resuscitation of consistent quality. PLoS One 2018; 13:e0208140. [PMID: 30485382 PMCID: PMC6261643 DOI: 10.1371/journal.pone.0208140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022] Open
Abstract
Ischemia-induced left ventricular (LV) wall thickening compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR). However, accurate assessment of the severity of ischemia-induced LV wall thickening during CPR is challenging. We investigated, in a swine model, whether hemodynamic parameters, including end-tidal carbon dioxide (ETCO2) level, are linearly associated with the severity of ischemia-induced LV wall thickening during CPR of consistent quality. We retrospectively analyzed 96 datasets for ETCO2 level, arterial pressure, LV wall thickness, and the percent of measured end-diastolic volume (%EDV) relative to EDV at the onset of ventricular fibrillation from eight pigs. Animals underwent advanced cardiovascular life support based on resuscitation guidelines. During CPR, LV wall thickness progressively increased while %EDV progressively decreased. Systolic and diastolic arterial pressure and ETCO2 level were significantly correlated with LV wall thickness and %EDV. Linear mixed effect models revealed that, after adjustment for significant covariates, systolic and diastolic arterial pressure were not associated with LV wall thickness or %EDV. ETCO2 level had a significant linear relationship with %EDV (P = 0.004). However, it could explain only 28.2% of the total variance of %EDV in our model. In conclusion, none of the hemodynamic parameters examined in this study appeared to provide sufficient information on the severity of ischemia-induced LV wall thickening.
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Affiliation(s)
- Se-hyeok Park
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Deok Lim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- * E-mail:
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A Dynamic Model of Rescuer Parameters for Optimizing Blood Gas Delivery during Cardiopulmonary Resuscitation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:3569346. [PMID: 30687409 PMCID: PMC6305043 DOI: 10.1155/2018/3569346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/11/2018] [Indexed: 11/26/2022]
Abstract
Introduction The quality of cardiopulmonary resuscitation (CPR) has been shown to impact patient outcomes. However, post-CPR morbidity and mortality remain high, and CPR optimization is an area of active research. One approach to optimizing CPR involves establishing reliable CPR performance measures and then modifying CPR parameters, such as compressions and ventilator breaths, to enhance these measures. We aimed to define a reliable CPR performance measure, optimize the CPR performance based on the defined measure and design a dynamically optimized scheme that varies CPR parameters to optimize CPR performance. Materials and Methods We selected total blood gas delivery (systemic oxygen delivery and carbon dioxide delivery to the lungs) as an objective function for maximization. CPR parameters were divided into three categories: rescuer dependent, patient dependent, and constant parameters. Two optimization schemes were developed using simulated annealing method: a global optimization scheme and a sequential optimization scheme. Results and Discussion Variations of CPR parameters over CPR sequences (cycles) were analyzed. Across all patient groups, the sequential optimization scheme resulted in significant enhancement in the effectiveness of the CPR procedure when compared to the global optimization scheme. Conclusions Our study illustrates the potential benefit of considering dynamic changes in rescuer-dependent parameters during CPR in order to improve performance. The advantage of the sequential optimization technique stemmed from its dynamically adapting effect. Our CPR optimization findings suggest that as CPR progresses, the compression to ventilation ratio should decrease, and the sequential optimization technique can potentially improve CPR performance. Validation in vivo is needed before implementing these changes in actual practice.
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Paiva EF, Paxton JH, O’Neil BJ. Data supporting the use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review. Data Brief 2018; 18:1497-1508. [PMID: 29904652 PMCID: PMC5998212 DOI: 10.1016/j.dib.2018.04.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 12/02/2022] Open
Abstract
The data presented in this article are related to the research article, "The Use of End-Tidal Carbon Dioxide (ETCO2) Measurement to Guide Management of Cardiac Arrest: A Systematic Review" [1]. This article is a systematic review and meta-analysis of existing data on the subject of whether any level of end-tidal carbon dioxide (ETCO2) measured during cardiopulmonary resuscitation (CPR) correlates with return of spontaneous circulation (ROSC) or survival in adult patients experiencing cardiac arrest in any setting. These data are made publicly available to enable critical or extended analyses.
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Affiliation(s)
- Edison F. Paiva
- University of São Paulo School of Medicine, Butantã, São Paulo 03178-200, Brazil
| | - James H. Paxton
- Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Brian J. O’Neil
- Wayne State University School of Medicine, Detroit, MI 48201, USA
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Modrin A, Gilbert ML. De l’entrée à la sortie du service de réanimation adulte : une mise au point sur l’utilisation courante du monitoring du CO 2 expiré. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’objectif de cette mise au point est d’effectuer une revue des indications de l’utilisation du monitorage du CO2 expiré en réanimation adulte. De par sa physiologie, sa mesure est un reflet de l’état hémodynamique, respiratoire et métabolique du patient. La spectrométrie infrarouge est la méthode de mesure la plus courante. La capnographie commune (CO2 expiré en fonction du temps) est divisée en plusieurs phases dont l’analyse visuelle peut faire évoquer de nombreuses anomalies ventilatoires. La capnographie volumétrique fournit une mesure de l’espace mort. La capnométrie est recommandée en réanimation pour contrôler l’intubation trachéale ou bien au cours d’un arrêt cardiorespiratoire comme facteur pronostique. Tout patient traité par ventilation mécanique invasive, surtout lors d’un transport, doit être équipé d’un capnomètre afin d’anticiper toute complication respiratoire (extubation, bronchospasme, hypoventilation). La pression de fin d’expiration en CO2 (PetCO2) est une évaluation de la pression artérielle en CO2 (PaCO2) utile pour limiter le nombre de prélèvements biologiques, par exemple en neuroréanimation, mais de nombreux facteurs font varier le gradient entre ces deux valeurs. Les études n’apportent pas de preuve pour l’utilisation de la capnographie volumétrique dans le diagnostic d’embolie pulmonaire en réanimation. Chez les patients souffrant de syndrome de détresse respiratoire aiguë, la littérature médicale n’apporte pas de preuve suffisante pour un intérêt en pratique clinique courante de la capnométrie volumétrique qui semble limitée dans ce cas à la recherche.
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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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Brinkrolf P, Borowski M, Metelmann C, Lukas RP, Pidde-Küllenberg L, Bohn A. Predicting ROSC in out-of-hospital cardiac arrest using expiratory carbon dioxide concentration: Is trend-detection instead of absolute threshold values the key? Resuscitation 2017; 122:19-24. [PMID: 29146493 DOI: 10.1016/j.resuscitation.2017.11.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 10/31/2017] [Accepted: 11/13/2017] [Indexed: 12/25/2022]
Abstract
AIM Guidelines recommend detecting return of spontaneous circulation (ROSC) by a rising concentration of carbon dioxide in the exhalation air. As CO2 is influenced by numerous factors, no absolute cut-off values of CO2 to detect ROSC are agreed on so far. As trends in CO2 might be less affected by influencing factors, we investigated an approach which is based on detecting CO2-trends in real-time. METHODS We conducted a retrospective case-control study on 169 CO2 time series from out of hospital cardiac arrests resuscitated by Muenster City Ambulance-Service, Germany. A recently developed statistical method for real-time trend-detection (SCARM) was applied to each time series. For each series, the percentage of time points with detected positive and negative trends was determined. RESULTS ROSC time series had larger percentages of positive trends than No-ROSC time series (p=0.003). The median percentage of positive trends was 15% in the ROSC time series (IQR: 5% to 23%) and 7% in the No-ROSC time series (IQR: 3% to 14%). A receiver operating characteristic (ROC) analysis yielded an optimal threshold of 13% to differentiate between ROSC and No-ROSC cases with a specificity of 58.4% and sensitivity of 73.9%; the area under the curve was 63.5%. CONCLUSION Patients with ROSC differed from patients without ROSC as to the percentage of detected CO2 trends, indicating the potential of our real-time trend-detection approach. Since the study was designed as a proof of principle and its calculated specificity and sensitivity are low, more research is required to implement CO2-trend-detection into clinical use.
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Affiliation(s)
- Peter Brinkrolf
- Department of Anaesthesiology, University Medicine Greifswald, Germany.
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Germany
| | - Roman-Patrik Lukas
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
| | - Laura Pidde-Küllenberg
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
| | - Andreas Bohn
- City of Muenster Fire Department, Muenster, Germany
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Capnography Use During Intubation and Cardiopulmonary Resuscitation in the Pediatric Emergency Department. Pediatr Emerg Care 2017; 33:457-461. [PMID: 27455341 PMCID: PMC5259553 DOI: 10.1097/pec.0000000000000813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Capnography is indicated as a guide to assess and monitor both endotracheal intubation and cardiopulmonary resuscitation (CPR). Our primary objective was to determine the effect of the 2010 American Heart Association (AHA) guidelines on the frequency of capnography use during critical events in children in the emergency department (ED). Our secondary objective was to examine associations between patient characteristics and capnography use among these patients. METHODS A retrospective chart review was performed on children aged 0 to 21 years who were intubated or received CPR in 2 academic children's hospital EDs between January 2009 and December 2012. Age, sex, time of arrival, medical or traumatic cause, length of CPR, return of spontaneous circulation (ROSC), documented use of capnography and colorimetry, capnography values, and adverse events were recorded. RESULTS Two hundred ninety-two patients were identified and analyzed. Intubation occurred in 95% of cases and CPR in 30% of cases. Capnography was documented in only 38% of intubated patients and 13% of patients requiring CPR. There was an overall decrease in capnography use after publication of the 2010 AHA recommendations (P = 0.05). Capnography use was associated with a longer duration of CPR and return of spontaneous circulation. CONCLUSIONS Despite the 2010 AHA recommendations, a minority of critically ill children are being monitored with capnography and an unexpected decrease in documented use occurred among our sample. Further education and implementation of capnography should take place to improve the use of this monitoring device for critically ill pediatric patients in the ED.
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Wang AY, Huang CH, Chang WT, Tsai MS, Wang CH, Chen WJ. Initial end-tidal CO 2 partial pressure predicts outcomes of in-hospital cardiac arrest. Am J Emerg Med 2016; 34:2367-2371. [PMID: 27638460 DOI: 10.1016/j.ajem.2016.08.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/03/2016] [Accepted: 08/20/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Monitoring the partial pressure of end-tidal carbon dioxide (PEtco2) has been advocated since 2010 as an index of resuscitation efforts. However, related research has largely focused on out-of-hospital cardiac arrest victims. In-hospital cardiac arrest (IHCA) differs in terms of etiologies and demographics, the merit of initial PEtco2 values was explored. METHODS This was a retrospective study in a single medical center between February 2011 and August 2014. Eligible subjects had suffered nontraumatic IHCA in the emergency department, where resuscitation was performed in accord with 2010 American Heart Association guidelines. Patients with initial PEtco2 recordings via capnography were recruited. RESULTS A total of 353 IHCA events with initial PEtco2 were recorded in 202 patients (male, 61.4%; mean age, 67.0 ± 16.2 years). Shockable rhythm (ventricular tachycardia/ventricular fibrillation) accounted for 11.8%. A cut point of 25.5 mm Hg was established for initial PEtco2, creating 2 tiers of sustained return of spontaneous circulation (ROSC) that differed significantly in cumulative survival probability (log rank test, P = .002). For patients with initial PEtco2 <25.5 mm Hg, survival benefit ceased at an earlier point in resuscitation, whereas above this threshold, the probability of survival cumulatively increased for a longer period. In multivariate analysis, initial PEtco2 >25.5 mm Hg was found independently predictive of sustained ROSC (odds ratio, 2.64; 95% confidence interval, 1.43-4.88; P = .002), and survival to discharge (odds ratio, 3.10; 95% confidence interval, 1.26-7.60; P = .014), but failed to correlate with neurologic outcome. CONCLUSION In IHCA, the therapeutic threshold for initial PEtco2 should set fairly higher to encourage more pulmonary flow and increase the likelihood of sustained ROSC.
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Affiliation(s)
- An-Yi Wang
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Departments of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chien-Hua Huang
- Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Tien Chang
- Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Shan Tsai
- Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Wang
- Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Departments of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 926] [Impact Index Per Article: 115.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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Ryu SJ, Lee SJ, Park CH, Lee SM, Lee DH, Cho YS, Jung YH, Lee BK, Jeung KW. Arterial pressure, end-tidal carbon dioxide, and central venous oxygen saturation in reflecting compression depth. Acta Anaesthesiol Scand 2016; 60:1012-23. [PMID: 27080141 DOI: 10.1111/aas.12728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND We sought to investigate the utility of arterial pressure, end-tidal carbon dioxide (ETCO2 ), and central venous oxygen saturation (SCVO2 ) to guide compression depth adjustment. Thus, in a pig model of cardiac arrest, we observed these parameters during cardiopulmonary resuscitation (CPR) with optimal and suboptimal compression depths. METHODS Sixteen pigs underwent three experimental sessions after induction of ventricular fibrillation. First, the animals received two 4-min CPR trials with either optimal (20% of the anteroposterior diameter) or suboptimal (70% of the optimal depth) compression depth. Second, the animals received two 5-min CPR trials with optimal compression depth, in which adrenaline (0.02 mg/kg) or saline placebo was administered. Third, the animals randomly received compression with either optimal or suboptimal depth during advanced cardiovascular life support. RESULTS The systolic arterial pressure reflected compression depth most accurately and immediately (area under the curve [AUC], 0.895-0.939 without adrenaline and 0.928-1.000 with adrenaline). Although the response of ETCO2 to the change in compression depth was 0.5 min slower than that of the systolic arterial pressure, the performance of ETCO2 was comparable with that of systolic arterial pressure. SCVO2 did not reflect compression depth. Adrenaline administration remarkably increased systolic arterial pressure, diastolic arterial pressure, and coronary perfusion pressure but did not affect the ETCO2 readings. CONCLUSION In a pig model of cardiac arrest, systolic arterial pressure reflected compression depth immediately and accurately. The performance of ETCO2 was comparable with that of systolic arterial pressure. SCVO2 did not reflect compression depth.
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Affiliation(s)
- S-J. Ryu
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - S-J. Lee
- Department of Emergency Medicine; Myongji Hospital; Goyang Gyeonggi-do Korea
| | - C-H. Park
- Department of Emergency Medicine; Myongji Hospital; Goyang Gyeonggi-do Korea
| | - S-M. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - D-H. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - Y-S. Cho
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - Y-H. Jung
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - B-K. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - K-W. Jeung
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
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Xu J, Li C, Li Y, Walline J, Zheng L, Fu Y, Yao D, Zhu H, Liu X, Chai Y, Wang Z, Yu X. Influence of Chest Compressions on Circulation during the Peri-Cardiac Arrest Period in Porcine Models. PLoS One 2016; 11:e0155212. [PMID: 27168071 PMCID: PMC4864302 DOI: 10.1371/journal.pone.0155212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/26/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Starting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC) and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the peri-cardiac arrest period. Design Prospective, randomized controlled study. Setting Animal experimental center in Peking Union Medical Collage Hospital, Beijing, China. Subjects Healthy 3-month-old male domestic pigs. Interventions 44 pigs (28±2 kg) were randomly assigned to three groups: Group I (non-arrested with compressions) (n = 12); Group II (arrested with compressions only) (n = 12); Group III (ROSC after compressions and defibrillation) (n = 20). In Groups I and II, compressions were performed to a depth of 5cm (Ia and IIa, n = 6) or a depth of 3cm (Ib and IIb, n = 6) respectively, while in Group III, the animals which had just achieved ROSC (n = 18) were compressed to a depth of 5cm (IIIa, n = 6), a depth of 3cm (IIIb, n = 6), or had no compressions (IIIc, n = 6). Hemodynamic parameters were collected and analyzed. Measurements and Findings Hemodynamics were statistically different between Groups Ia and Ib when different depths of compressions were performed (p < 0.05). In Group II, compressions were beneficial and hemodynamics correlated with the depth of compressions (p < 0.05). In Group III, compressions that continued after ROSC produced a reduction in arterial pressure (p < 0.05). Conclusions Chest compressions might be detrimental to hemodynamics in the early post-ROSC stage. The deeper the compressions were, the better the effect on hemodynamics during cardiac arrest, but the worse the effect on hemodynamics after ROSC.
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Affiliation(s)
- Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Li
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Joseph Walline
- Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America
| | - Liangliang Zheng
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongqi Yao
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohe Liu
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanfen Chai
- Emergency Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhong Wang
- Emergency Department, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
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Zhang Y, Li CS, Wu CJ, Yang J, Hang CC. Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models. Chin Med J (Engl) 2016; 128:1643-8. [PMID: 26063367 PMCID: PMC4733747 DOI: 10.4103/0366-6999.158340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Morbidity and mortality after resuscitation largely depend on the recovery of brain function. Ventricular fibrillation cardiac arrest (VFCA) and asphyxial cardiac arrest (ACA) are the two most prevalent causes of sudden cardiac death. Up to now, most studies have focused on VFCA. However, results from the two models have been largely variable. So, it is necessary to characterize the features of postresuscitation cerebral metabolism of both models. METHODS Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: 18 for VFCA group, ACA group, respectively, and other 8 for sham-operated group (SHAM). VFCA was induced by programmed electric stimulation, and ACA was induced by endotracheal tube clamping. After 8 min without treatment, standard cardiopulmonary resuscitation (CPR) was initiated. Following neurological deficit scores (NDS) were evaluated at 24 h after achievement of spontaneous circulation, cerebral metabolism showed as the maximum standardized uptake value (SUVmax) was measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. Levels of serum markers of brain injury, neuron specific enolase (NSE), and S100β were quantified with an enzyme-linked immunosorbent assay. RESULTS Compared with VFCA group, fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs. 94.4%, P < 0.01) and survived 24-h after resuscitation (38.9% vs. 77.8%, P < 0.01) with worse neurological outcome (NDS: 244.3 ± 15.3 vs. 168.8 ± 9.71, P < 0.01). The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs. 4.5 ± 1.1 min, P < 0.01). Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01). Higher serum biomarkers of brain damage (NSE, S100β) were found in ACA than VFCA after resuscitation (P < 0.01). CONCLUSIONS Compared with VFCA, ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.
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Affiliation(s)
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Varvarousis D, Varvarousi G, Iacovidou N, D'Aloja E, Gulati A, Xanthos T. The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management. Am J Emerg Med 2015; 33:1297-304. [PMID: 26233618 DOI: 10.1016/j.ajem.2015.06.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiac arrest is not a uniform condition and significant heterogeneity exists within all victims with regard to the cause of cardiac arrest. Primary cardiac (dysrhythmic) and asphyxial causes together are responsible for most cases of cardiac arrest at all age groups. The purpose of this article is to review the pathophysiologic differences between dysrhythmic and asphyxial cardiac arrest in the prearrest period, during the no-flow state, and after successful cardiopulmonary resuscitation. METHODS The electronic databases of PubMed/Medline, Scopus, and Cochrane were searched for relevant literature and studies. RESULTS/DISCUSSION Significant differences exist between dysrhythmic and asphyxial cardiac arrest regarding their pathophysiologic pathways and affect consequently the postresuscitation period. Laboratory data indicate that asphyxial cardiac arrest leads to more widespread postresuscitation brain damage compared with dysrhythmic cardiac arrest. Regarding postresuscitation myocardial dysfunction, few studies have addressed a comparison of the 2 conditions with controversial results. CONCLUSIONS Asphyxial cardiac arrest differs significantly from dysrhythmic cardiac arrest with regard to pathophysiologic mechanisms, neuropathologic damage, postresuscitation organ dysfunction, and response to therapy. Both conditions should be considered and treated in a different manner.
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Affiliation(s)
- Dimitrios Varvarousis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
| | - Giolanda Varvarousi
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nicoletta Iacovidou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ernesto D'Aloja
- Forensic Science Unit, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, 09042 Monserrato, Italy
| | - Anil Gulati
- College of Pharmacy, Midwestern University, Downers Grove, IL
| | - Theodoros Xanthos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; College of Pharmacy, Midwestern University, Downers Grove, IL
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A Review of Carbon Dioxide Monitoring During Adult Cardiopulmonary Resuscitation. Heart Lung Circ 2015; 24:1053-61. [PMID: 26150002 DOI: 10.1016/j.hlc.2015.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/03/2015] [Accepted: 05/07/2015] [Indexed: 12/17/2022]
Abstract
Although high quality cardiopulmonary resuscitation is one of the most significant factors related to favourable outcome, its quality depends on many components, such as airway management, compression depth and chest recoil, hands-off time, and early defibrillation. The most common way of controlling the resuscitation efforts is monitoring of end-tidal carbon dioxide. The International Liaison Committee on Resuscitation suggests this method both for in-hospital and out-of-hospital cardiac arrest. However, despite the abundant human and animal studies supporting the usefulness of end-tidal carbon dioxide, its optimal values during cardiopulmonary resuscitation remain controversial. In this review, the advantages and effectiveness of end-tidal carbon dioxide during cardiopulmonary resuscitation are discussed and specific target values are suggested based on the available literature.
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Pearce AK, Davis DP, Minokadeh A, Sell RE. Initial end-tidal carbon dioxide as a prognostic indicator for inpatient PEA arrest. Resuscitation 2015; 92:77-81. [PMID: 25939324 DOI: 10.1016/j.resuscitation.2015.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/24/2015] [Accepted: 04/23/2015] [Indexed: 01/05/2023]
Abstract
AIM Investigate the relationship of initial PetCO2 values of patients during inpatient pulseless electrical activity (PEA) cardiopulmonary arrest with return of spontaneous circulation (ROSC) and survival to discharge. METHODS This study was performed in two urban, academic inpatient hospitals. Patients were enrolled from July 2009 to July 2013. A comprehensive database of all inpatient resuscitative events is maintained at these institutions, including demographic, clinical, and outcomes data. Arrests are stratified by primary etiology of arrest using a priori criteria. Inpatients with PEA arrest for whom recorded PetCO2 was available were included in the analysis. Capnography data obtained after ROSC and/or more than 10 min after initiation of CPR were excluded. Multivariable logistic regression was used to explore the association between initial PetCO2 >20 mmHg and both ROSC and survival-to-discharge. RESULTS A total of 50 patients with PEA arrest and pre-ROSC capnography were analyzed. CPR continued an average of 11.8 min after initial PetCO2 was recorded confirming absence of ROSC at time of measurement. Initial PetCO2 was higher in patients with versus without eventual ROSC (25.3 ± 14.4 mmHg versus 13.4 ± 6.9 mmHg, P = 0.003). After adjusting for age, gender, and arrest location (ICU versus non-ICU), initial PetCO2 >20 mmHg was associated with increased likelihood of ROSC (adjusted OR 4.8, 95% CI 1.2-19.2, P = 0.028). Initial PetCO2 was not significantly associated with survival-to-discharge (P = 0.251). CONCLUSIONS Initial PetCO2 >20 mmHg during CPR was associated with ROSC but not survival-to-discharge among inpatient PEA arrest victims. This analysis is limited by relatively small sample size.
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Affiliation(s)
- Alex K Pearce
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Daniel P Davis
- Department of Emergency Medicine, UC San Diego, San Diego, CA, United States
| | - Anushirvan Minokadeh
- Division of Anesthesiology & Critical Care, Department of Anesthesia, UC San Diego, San Diego, CA, United States
| | - Rebecca E Sell
- Division of Pulmonary & Critical Care, Department of Medicine, UC San Diego, 9300 Campus Point Drive #7381, La Jolla, CA, United States.
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Lin QM, Fang XS, Zhou LL, Fu Y, Zhu J, Huang ZT. Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest. World J Emerg Med 2014; 5:116-21. [PMID: 25215160 DOI: 10.5847/wjem.j.issn.1920-8642.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partial pressure of end-tidal carbon dioxide (PETCO2) has been used to monitor the effectiveness of precordial compression (PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation (CPR). This study was to investigate changes of PETCO2 during CPR in rats with ventricular fibrillation (VF) versus asphyxial cardiac arrest. METHODS Sixty-two male Sprague-Dawley (SD) rats were randomly divided into an asphyxial group (n=32) and a VF group (n=30). PETCO2 was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest. RESULTS The initial values of PETCO2 immediately after PC in the VF group were significantly lower than those in the asphyxial group (12.8±4.87 mmHg vs. 49.2±8.13 mmHg, P=0.000). In the VF group, the values of PETCO2 after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation (ROSC), compared with those in rats without ROSC (16.5±3.07 mmHg vs. 13.2±2.62 mmHg, P=0.004). In the asphyxial group, the values of PETCO2 after 2 minutes of PC in rats with ROSC were significantly higher than those in rats without ROSC (20.8±3.24 mmHg vs. 13.9±1.50 mmHg, P=0.000). Receiver operator characteristic (ROC) curves of PETCO2 showed significant sensitivity and specificity for predicting ROSC in VF versus asphyxial cardiac arrest. CONCLUSIONS The initial values of PETCO2 immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of PETCO2 during CPR can predict outcomes of CPR.
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Affiliation(s)
- Qing-Ming Lin
- Department of Emergency Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Xiang-Shao Fang
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Li-Li Zhou
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yue Fu
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jun Zhu
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zi-Tong Huang
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Systematic Review and Meta-Analysis of End-Tidal Carbon Dioxide Values Associated With Return of Spontaneous Circulation During Cardiopulmonary Resuscitation. J Intensive Care Med 2014; 30:426-35. [DOI: 10.1177/0885066614530839] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/20/2014] [Indexed: 11/15/2022]
Abstract
Objective: End-tidal carbon dioxide (ETCO2) measurements during cardiopulmonary resuscitation (CPR) reflect variable cardiac output over time, and low values have been associated with decreased survival. The goals of this review are to confirm and quantify this relationship and to determine the mean ETCO2 value among patients with return of spontaneous circulation (ROSC) as an initial step toward determining an appropriate target for intervention during resuscitation in the absence of prospective data. Data Sources and Study Selection: The PubMed database was searched for the key words “end-tidal carbon dioxide” or “capnometry” or “capnography” and “resuscitation” or “return of spontaneous circulation.” Randomized controlled trials, cohort studies, or case–control studies that reported ETCO2 values for participants with and without ROSC were included. Data Extraction and Synthesis: Twenty-seven studies met the inclusion criteria for qualitative synthesis. Twenty studies were included in determination of average ETCO2 values. The mean ETCO2 in participants with ROSC was 25.8 ± 9.8 mm Hg versus 13.1 ± 8.2 mm Hg ( P = .001) in those without ROSC. Nineteen studies were included in a meta-analysis. The mean difference in ETCO2 was 12.7 mm Hg (95% confidence interval: 10.3-15.1) between participants with and without ROSC ( P < .001). The mean difference in ETCO2 was not modified by the receipt of sodium bicarbonate, uncontrolled minute ventilation, or era of resuscitation guidelines. The overall quality of data by Grades of Recommendations, Assessment, Development and Evaluation criteria is very low, but no prospective data are currently available. Conclusions: Participants with ROSC after CPR have statistically higher levels of ETCO2. The average ETCO2 level of 25 mm Hg in participants with ROSC is notably higher than the threshold of 10 to 20 mm Hg to improve delivery of chest compressions. The ETCO2 goals during resuscitation may be higher than previously suggested and further investigation into appropriate targets during resuscitation is needed to diminish morbidity and mortality after cardiorespiratory arrest.
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Camp-Rogers T, Sawyer KN. Non-invasive monitoring during cardiac arrest: NIRS has potential but data remain limited. Resuscitation 2013; 84:1643-4. [PMID: 24210221 DOI: 10.1016/j.resuscitation.2013.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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Touma O, Davies M. The prognostic value of end tidal carbon dioxide during cardiac arrest: A systematic review. Resuscitation 2013; 84:1470-9. [DOI: 10.1016/j.resuscitation.2013.07.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
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Youngquist ST. Can survival from out-of-hospital cardiac arrest be predicted from a victim's carbon emissions? Resuscitation 2013; 84:1457-8. [PMID: 24036197 DOI: 10.1016/j.resuscitation.2013.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Scott T Youngquist
- Department of Surgery, Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
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Qvigstad E, Kramer-Johansen J, Tømte Ø, Skålhegg T, Sørensen Ø, Sunde K, Olasveengen TM. Clinical pilot study of different hand positions during manual chest compressions monitored with capnography. Resuscitation 2013; 84:1203-7. [DOI: 10.1016/j.resuscitation.2013.03.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/30/2012] [Accepted: 03/09/2013] [Indexed: 01/24/2023]
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Predicting a pulse: Can monitoring heart rate and end-tidal carbon dioxide minimize compression pauses and impact outcomes in out-of-hospital cardiac arrest? Resuscitation 2013; 84:3-4. [DOI: 10.1016/j.resuscitation.2012.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 09/30/2012] [Indexed: 11/18/2022]
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Bae SJ, Lee BK, Kim KT, Jeung KW, Lee HY, Jung YH, Lee GS, Kim SP, Lee SJ. Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.1.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sei Jong Bae
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ki Tae Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyoung Youn Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Geo Sung Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sun Pyo Kim
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Seung Joon Lee
- Department of Emergency Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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Goldberg SA, Metzger JC, Pepe PE. Year in review 2011: Critical Care--Out-of-hospital cardiac arrest and trauma. Crit Care 2012; 16:247. [PMID: 23249434 PMCID: PMC3672581 DOI: 10.1186/cc11832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In 2011, numerous studies were published in Critical Care focusing on out-of-hospital cardiac arrest, cardiopulmonary resuscitation, trauma, and some related airway, respiratory, and response time factors. In this review, we summarize several of these studies, including those that brought forth advances in therapies for the post-resuscitative period. These advances involved hypothesis-generating concepts in therapeutic hypothermia as well as the impact of early percutaneous coronary artery interventions and the potential utility of extracorporeal life support after cardiac arrest. There were also articles pertaining to the importance of timing in prehospital airway management, the outcome impact of hyperoxia, and the timing of end-tidal carbon dioxide measurements to predict futility in cardiac arrest resuscitation. In other articles, additional perspectives were provided on the classic correlations between emergency medical service response intervals and outcomes.
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Affiliation(s)
- Scott A Goldberg
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
| | - Jeffery C Metzger
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
| | - Paul E Pepe
- Emergency Medicine Administration, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, MC 8579, Dallas, TX 75390-8579, USA
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Factors complicating interpretation of capnography during advanced life support in cardiac arrest—A clinical retrospective study in 575 patients. Resuscitation 2012; 83:813-8. [DOI: 10.1016/j.resuscitation.2012.02.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/07/2012] [Accepted: 02/15/2012] [Indexed: 11/19/2022]
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