Continuous capnography monitoring during resuscitation in a transitional large mammalian model of asphyxial cardiac arrest

Abstract

BACKGROUND In neonates requiring chest compression (CC) during resuscitation, neonatal resuscitation program (NRP) recommends against relying on a single feedback device such as end-tidal carbon dioxide (ETCO2) or saturations (SpO2) to determine return of spontaneous circulation (ROSC) until more evidence becomes available. METHODS We evaluated the role of monitoring ETCO2 during resuscitation in a lamb model of cardiac arrest induced by umbilical cord occlusion (n = 21). Lambs were resuscitated as per NRP guidelines. Systolic blood pressure (SBP), carotid and pulmonary blood flows along with ETCO2 and blood gases were continuously monitored. Resuscitation was continued for 20 min or until ROSC (whichever was earlier). Adequate CC was arbitrarily defined as generation of 30 mmHg SBP during resuscitation. ETCO2 thresholds to predict adequacy of CC and detect ROSC were determined. RESULTS Significant relationship between ETCO2 and adequate CC was noted during resuscitation (AUC-0.735, P < 0.01). At ROSC (n = 12), ETCO2 rapidly increased to 57 ± 20 mmHg with a threshold of ≥32 mmHg being 100% sensitive and 97% specific to predict ROSC. CONCLUSION In a large mammalian model of perinatal asphyxia, continuous ETCO2 monitoring predicted adequacy of CC and detected ROSC. These findings suggest ETCO2 in conjunction with other devices may be beneficial during CC and predict ROSC.

Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model

“…Moreover, quality of CPR provided was monitored using defibrillator with CPR quality analysis features and no other direct or invasive measurements of CPR quality was measured. In regard to EtCO 2, a recent study using a lamb asphyxial cardiac arrest model, Chandrasekharan et al demonstrated a relationship between EtCO 2 and adequate chest compression during resuscitation, and concluded that a rapid increase in EtCO 2 with a threshold of > 32 mmHg is 100 sensitive and 97% specific in predicting ROSC [29]. Moreover, a recent multicenter study of 583 adult patients with in-and out hospital CA showed that depth of chest compression was associated with higher EtCO 2 which suggest that EtCO 2 monitoring during CPR might be a useful tool to guide effective resuscitation after CA [30].…”

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

“…They were intubated with a 10.0 mm-cuffed endotracheal tube (ETT) and ventilated with 21% oxygen and 2–3% isoflurane at 16 breaths/min. The ewes were continuously monitored with a pulse oximeter and an end-tidal CO 2 (EtCO 2 ) monitor [9,10]. Following cesarean section, fetal lambs were partially exteriorized and intubated with a 4.5 mm-cuffed ETT as previously described [11].…”

Chest Compressions for Bradycardia during Neonatal Resuscitation—Do We Have Evidence?

“…Use of 100% oxygen is the current recommendation for ventilation during CC until the end of resuscitation or return of spontaneous circulation (ROSC), although the efficacy of this practice still needs evidence [28,29,30]. Research in CC during neonatal resuscitation has so far focused on different techniques of compression, depth of CC, use of sustained inflations, asynchronous ventilation, oxygen concentrations, and use of assisted devices to predict effective CC and ROSC [1,27,31,32,33,34]. The current recommendation to initiate CC for HR < 60/min during resuscitation is probably based on consensus rather than clear evidence.…”