Capnography during cardiac arrest

Sandroni, Claudio; Santis, Paolo De; D’Arrigo, Sonia

doi:10.1016/j.resuscitation.2018.08.018

Cited by 126 publications

(85 citation statements)

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“…Although multiple studies have assessed the usefulness of EtCO 2 as a guide to resuscitative efforts during CPR, there have been no studies assessing the use of volumetric capnography, especially VCO 2 , as a more comprehensive evaluation of the effectiveness of ventilation and perfusion to assess the quality of resuscitation or detection of ROSC. [22][23][24] In this study, we demonstrate that VCO 2 and EtCO 2 can be used to assess and potentially guide effectiveness of chest compressions especially when resuscitation efforts are suboptimal. Although VCO 2 is dependent on multiple parameters and resuscitation variables including minute ventilation, PBF, and metabolic rate, VCO 2 had a significant correlation with CO during resuscitation.…”

Section: Discussionmentioning

confidence: 76%

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: 76%

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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“…8,26−29 Respiratory acidosis, the other cause of severe acidaemia, indicates inadequate discharge of carbon dioxide and is mostly caused by low venous return by chest compression and insufficient alveolar ventilation during resuscitation. 25,30 Previous observational studies also reported that respiratory acidosis is associated with cerebral injury and unfavourable neurological outcome among post-cardiac arrest patients or those with head trauma injury. 31,32 Thus, it is reasonable that lower pH values may represent the severe conditions of longer duration of cardiac arrest, lower cerebral blood flow and venous return, and insufficient ventilation, and these conditions are associated with unfavourable neurological outcome.…”

Section: Interpretation Of the Resultsmentioning

confidence: 99%

Association between pH and neurological outcome among cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan

Okada

Irisawa

Yoshiya

et al. 2020

Preprint

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Background We aimed to identify the association of pH value in blood gas assessment with neurological outcome among out-of-hospital cardiac arrest (OHCA) patients treated by extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analysed the database of a multicentre prospective observational study to collect pre-hospital and in-hospital data among OHCA patients in Osaka prefecture, Japan (CRITICAL study), from 1 July 2012 to 31 December 2016. We included the adult OHCA patients treated by ECPR with blood gas assessment before starting ECPR. Patients with OHCA of external causes, such as trauma, were excluded. The patients were divided into three approximately equal groups based on the pH values. We conducted logistic regression analysis to identify the odds ratio (OR) and 95% confidence interval (CI) of the groups for the 1-month neurological favourable outcome adjusted by the potential confounders of sex, age, witnessed by bystander, CPR by bystander, pre-hospital initial cardiac rhythm, and cardiac rhythm on hospital arrival. Results Among the 9,822 patients in the database, 260 patients were finally included in the analysis. The three groups were Tertile 1: pH ≥7.030, Tertile 2: pH 6.875-7.029, and Tertile 3: pH<6.875. The adjusted OR of Tertiles 2 and 3 compared with Tertile 1 for 1-month favourable neurological outcome were 0.26 (95% CI: 0.10-0.63) and 0.24 (95% CI: 0.09-0.61), respectively. Conclusion This multi-institutional observational study showed that low pH value (<7.03) before the implementation of ECPR was associated with 1-month unfavourable neurological outcome among OHCA patients treated with ECPR. It may be helpful to consider the candidate for ECPR.

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“…In general, anaerobic glycolysis due to inadequate oxygen delivery causes lactate and metabolic acidosis [27,28]. Furthermore, insu cient discharge of carbon dioxide due to low venous return and inappropriate ventilation provokes respiratory acidosis [29], which leads to the movement of potassium from the intracellular to the extracellular compartment [30]; thus, a longer duration of resuscitation is indicated by higher potassium levels in cardiac arrest patients [31]. Therefore, low pH value and higher lactate and potassium are indicative of hypoperfusion in vital organs, and longer duration of the resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: A prospective observational cohort study in Japan

Okada

Irisawa

Yoshiya

et al. 2020

Preprint

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Background: There is little limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia.Methods: In this retrospective study, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0°C) who were registered from June 2014 to December 2017 and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH, lactate, and potassium for 1-month survival.Results: Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-month survival was 5.8% (44/754). The areas under the curve of the predictors and 95% confidence interval were as follows: pH 0.829 [0.767–0.877] and lactate 0.843 [0.793–0.882]. On setting the cutoff points of 6.9 in pH and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91; pH 0.91) and a low negative likelihood ratio (lactate: 0.14; pH 0.13), which are suitable to exclude survival to 1 month. Furthermore, in additional analysis that included only the patients with potassium values available, a cutoff point of 7.0 (mmol/L) for serum potassium had high sensitivity (0.96) and a low negative likelihood ratio (0.09).Conclusion: This study indicated the predictive accuracy of serum lactate, pH, and potassium for 1-month survival among adult OHCA patients with hypothermia. These biomarkers may help define a more appropriate resuscitation strategy. pH 6.9 and lactate 120 mg/dL can predictively rule out 1-month survival.

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Capnography during cardiac arrest

Cited by 126 publications

References 50 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

Association between pH and neurological outcome among cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan

Predictive accuracy of biomarkers for survival among cardiac arrest patients with hypothermia: A prospective observational cohort study in Japan

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