Abrupt rise of end tidal carbon dioxide level was a specific but non-sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest

Lui, Chun Tat; Poon, Kin Ming; Tsui, Kwok Leung

doi:10.1016/j.resuscitation.2016.04.018

Cited by 46 publications

(19 citation statements)

References 21 publications

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“…Our results were consistent with other studies which showed that a sudden increase in EtCO 2 during CPR could be used as an early indicator of ROSC. 27,28 Finally, our results suggested that EtCO 2 has greater CO monitoring accuracy than VCO 2 following ROSC; this might be secondary to a significant increase in carbon dioxide production and metabolism following cardiac arrest, which could increase VCO 2 without substantial changes in PBF. The use of VCO 2 following ROSC to monitor CO requires further investigations.…”

Section: Discussionmentioning

confidence: 73%

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Al‐Subu

Hacker

Eickhoff

et al. 2020

J Pediatr Intensive Care

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The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO2) and the volume of CO2 elimination (VCO2) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO2 and VCO2 had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 (p < 0.001) and 0.53 (p = 0.018), respectively. However, both EtCO2 and VCO2 had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 (p = 0.484) (95% confidence interval [CI], –0.51–0.83) and 0.25 (p = 0.566) (95% CI, –0.55–0.81), respectively. EtCO2 and VCO2 increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO2 and VCO2 and CO were weak 0.20 (p = 0.646) (95% CI, −0.59–0.79), and 0.27 (p = 0.543) (95% CI, −0.54–0.82) following epinephrine boluses. Continuous EtCO2 and VCO2 monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO2 and VCO2 to guide chest compression.

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Section: Discussionmentioning

confidence: 73%

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Al‐Subu

Hacker

Eickhoff

et al. 2020

J Pediatr Intensive Care

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“…Resuscitation guidelines highlight that an increase of ETCO 2 during CPR may indicate ROSC, and that low ETCO 2 values may reflect a poor patient prognosis. However, studies in this field have not yet achieved high sensitivity and specificity in ROSC detection, nor reported a strong correlation between the ETCO 2 level and resuscitation outcome [16][17][18][19][20]24]. We suggest that, since the ETCO 2 level varies significantly with ventilation rate, this parameter may act as an important confounding factor in the cited studies.…”

Section: Discussionmentioning

confidence: 79%

“…Waveform capnography, i.e., continuous measurement of CO 2 concentration with time, enables monitoring of ETCO 2 during CPR. Current advanced life support (ALS) resuscitation guidelines [12,13] emphasize the potential role of waveform capnography in monitoring CPR quality [14,15], in the early recognition of return of spontaneous circulation (ROSC) during CPR [16,17], and as a potential indicator of patient outcome [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have modeled the influence of chest compression quality (compression depth and rate) and ventilation rate on ETCO 2 during CPR using multivariate analysis [14,15]. Studies on ROSC detection and patient outcome rely on the comparison of measured ETCO 2 levels [16][17][18][19][20]24]. However, animal studies have suggested that ventilation rate significantly influences ETCO 2 levels [25].…”

Section: Introductionmentioning

confidence: 99%

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Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

et al. 2020

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Aim Current resuscitation guidelines recommend waveform capnography as an indirect indicator of perfusion during cardiopulmonary resuscitation (CPR). Chest compressions (CCs) and ventilations during CPR have opposing effects on the exhaled carbon dioxide (CO 2) concentration, which need to be better characterized. The purpose of this study was to model the impact of ventilations in the exhaled CO 2 measured from capnograms collected during outof-hospital cardiac arrest (OHCA) resuscitation. Methods We retrospectively analyzed OHCA monitor-defibrillator files with concurrent capnogram, compression depth, transthoracic impedance and ECG signals. Segments with CC pauses, two or more ventilations, and with no pulse-generating rhythm were selected. Thus, only ventilations should have caused the decrease in CO 2 concentration. The variation in the exhaled CO 2 concentration with each ventilation was modeled with an exponential decay function using non-linear-least-squares curve fitting. Results Out of the original 1002 OHCA dataset (one per patient), 377 episodes had the required signals, and 196 segments from 96 patients met the inclusion criteria. Airway type was endotracheal tube in 64.8% of the segments, supraglottic King LT-D™ in 30.1%, and unknown in 5.1%. Median (IQR) decay factor of the exhaled CO 2 concentration was 10.0% (7.8 − 12.9) with R 2 = 0.98(0.95 − 0.99). Differences in decay factor with airway type were not statistically significant (p = 0.17). From these results, we propose a model for estimating the contribution of CCs to the end-tidal CO 2 level between consecutive ventilations and for estimating the end-tidal CO 2 variation as a function of ventilation rate.

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“…An abrupt increase in end-tidal carbon dioxide level to normal value may serve as an indicator of ROSC [ 17 , 18 ]. However, capnogram is only available with intubation and suffers low sensitivity in ROSC detection [ 19 ]. A false negative may lead to continued CC despite a PR and may increase the probability of unnecessary re-fibrillation [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Detection of spontaneous pulse using the acceleration signals acquired from CPR feedback sensor in a porcine model of cardiac arrest

et al. 2017

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BackgroundReliable detection of return of spontaneous circulation with minimal interruptions of chest compressions is part of high-quality cardiopulmonary resuscitation (CPR) and routinely done by checking pulsation of carotid arteries. However, manual palpation was time-consuming and unreliable even if performed by expert clinicians. Therefore, automated accurate pulse detection with minimal interruptions of chest compression is highly desirable during cardiac arrest especially in out-of-hospital settings.ObjectiveTo investigate whether the acceleration (ACC) signals acquired from accelerometer-based CPR feedback sensor can be used to distinguish perfusing rhythm (PR) from pulseless electrical activity (PEA) in a porcine model of cardiac arrest.MethodsCardiac arrest was induced in 49 male adult pigs. ECG, arterial blood pressure (ABP) and ACC waveforms were simultaneously recorded during CPR. 3-second segments containing compression-free signals during chest compression pauses were extracted and only those segments with organized rhythm were used for analysis. PR was defined as systolic arterial pressure >60 mmHg and pulse pressure >10 mmHg, while PEA was defined as an organized rhythm that does not meet the above criteria for PR. Peak correlation coefficient (CCp) of the cross-correlation function between pre-processed ECG and ACC, was used to discriminate PR and PEA.Results63 PR and 153 PEA were identified from the total of 1025 extracted segments. CCp was significantly higher for PR as compared to PEA (0.440±0.176 vs. 0.067±0.042, p<0.01) and highly correlated with ABP (r = 0.848, p<0.001). The area under the receiver operating characteristic curve, sensitivity, specificity and accuracy were 0.965, 93.6%, 97.5% and 96.7% for the ACC-based automatic spontaneous pulse detection.ConclusionsIn this animal model, the ACC signals acquired from an accelerometer-based CPR feedback sensor can be used to detect the presence of spontaneous pulse with high accuracy.

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Abrupt rise of end tidal carbon dioxide level was a specific but non-sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest

Abstract: The feature of an abrupt rise of ETCO2 was a specific but non-sensitive marker of ROSC in patient with out-of-hospital cardiac arrest.

Cited by 46 publications

References 21 publications

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

Detection of spontaneous pulse using the acceleration signals acquired from CPR feedback sensor in a porcine model of cardiac arrest

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