Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Al‐Subu, Awni; Jooste, Edmund H.; Hornik, Christoph P.; Fleming, Gregory A.; Cheifetz, Ira M.; Ofori-Amanfo, George

doi:10.1111/pan.13423

Cited by 3 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, poor correlation between cardiac output and VCO 2 is seen in patients with single ventricle physiology and significant intracardiac shunts. 11 In our series, VCO 2 remained similar to predecannulation levels or improved suggesting adequacy of Q p (and hence cardiac output). VCO 2 did trend lower in the two nonsurvivors as well as in the patient with dilated cardiomyopathy where ECMO was used as a bridge to LVAD placement, suggesting poor cardiac output/Q p .…”

Section: Discussionsupporting

confidence: 64%

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

Derespina

Medar

Aydin

et al. 2020

J Pediatr Intensive Care

Self Cite

View full text Add to dashboard Cite

The kinetics of carbon dioxide elimination (VCO2) may be used as a surrogate for pulmonary blood flow. As such, we can apply a novel use of volumetric capnography to assess hemodynamic stability in patients requiring extracorporeal membrane oxygenation (ECMO). We report our experience of pediatric patients requiring ECMO support who were monitored using volumetric capnography. We describe the use of VCO2 and its association with successful decannulation. This is a prospective observational study of pediatric patients requiring ECMO support at The Children's Hospital at Montefiore from 2017 to 2019. A Respironics NM3 monitor was applied to each patient. Demographics, hemodynamic data, blood gases, and VCO2 (mL/min) data were collected. Data were collected immediately prior to and after decannulation. Over the course of the study period, seven patients were included. Predecannulation VCO2 was higher among patients who were successfully decannulated than nonsurvivors (109 [35, 230] vs. 12.4 [7.6, 17.2] mL/min), though not statistically significant. Four patients (57%) survived without further mechanical support; two (29%) died, and one (14%) was decannulated to Berlin. Predecannulation VCO2 appears to correlate with hemodynamic stability following decannulation. This case series adds to the growing literature describing the use of volumetric capnography in critical care medicine, particularly pediatric patients requiring ECMO. Prospective studies are needed to further elucidate the use of volumetric capnography and optimal timing for ECMO decannulation.

show abstract

Section: Discussionsupporting

confidence: 64%

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

Derespina

Medar

Aydin

et al. 2020

J Pediatr Intensive Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Alteration of minute ventilation causes EtCO 2 and VCO 2 to move in opposite directions, while changes in PBF, and by extension CO, move EtCO 2 and VCO 2 in the same direction. 25 Therefore, the use of both VCO 2 and EtCO 2 during resuscitation might ensure that changes in EtCO 2 are secondary to changes in the quality of chest compression rather than changes in minute ventilation. Berg et al 26 showed that in asphyxia cardiac arrest that EtCO 2 was initially elevated during the first few breaths of CPR and rapidly dropped.…”

Section: Discussionmentioning

confidence: 99%

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Indirect cardiac output assessment in a swine pediatric acute respiratory distress syndrome model

Miller,

Braun,

Golding

et al. 2024

Respiratory Physiology & Neurobiology

View full text Add to dashboard Cite

Correlation between minute carbon dioxide elimination and pulmonary blood flow in single‐ventricle patients after stage 1 palliation and 2‐ventricle patients with intracardiac shunts: A pilot study

Abstract: Volume of CO elimination may be a surrogate marker of pulmonary blood flow in single-ventricle patients and patients with biventricular physiology with intracardiac shunting. Also, among patients with normal cardiac anatomy, volume of CO elimination may be a marker of cardiac output.

Cited by 3 publications

References 20 publications

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

Volumetric Capnography in Pediatric Extracorporeal Membrane Oxygenation: A Case Series

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

Indirect cardiac output assessment in a swine pediatric acute respiratory distress syndrome model

Contact Info

Product

Resources

About