Efficacy of Chest Compressions Directed by End‐Tidal CO ₂ Feedback in a Pediatric Resuscitation Model of Basic Life Support

Abstract

BackgroundEnd‐tidal carbon dioxide (ETCO2) correlates with systemic blood flow and resuscitation rate during cardiopulmonary resuscitation (CPR) and may potentially direct chest compression performance. We compared ETCO2‐directed chest compressions with chest compressions optimized to pediatric basic life support guidelines in an infant swine model to determine the effect on rate of return of spontaneous circulation (ROSC).Methods and ResultsForty 2‐kg piglets underwent general anesthesia, tracheostomy, placement of vascular catheters, ventricular fibrillation, and 90 seconds of no‐flow before receiving 10 or 12 minutes of pediatric basic life support. In the optimized group, chest compressions were optimized by marker, video, and verbal feedback to obtain American Heart Association‐recommended depth and rate. In the ETCO2‐directed group, compression depth, rate, and hand position were modified to obtain a maximal ETCO2 without video or verbal feedback. After the interval of pediatric basic life support, external defibrillation and intravenous epinephrine were administered for another 10 minutes of CPR or until ROSC. Mean ETCO2 at 10 minutes of CPR was 22.7±7.8 mm Hg in the optimized group (n=20) and 28.5±7.0 mm Hg in the ETCO2‐directed group (n=20; P=0.02). Despite higher ETCO2 and mean arterial pressure in the latter group, ROSC rates were similar: 13 of 20 (65%; optimized) and 14 of 20 (70%; ETCO2 directed). The best predictor of ROSC was systemic perfusion pressure. Defibrillation attempts, epinephrine doses required, and CPR‐related injuries were similar between groups.ConclusionsThe use of ETCO2‐directed chest compressions is a novel guided approach to resuscitation that can be as effective as standard CPR optimized with marker, video, and verbal feedback.

End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*

“…A novel physiologic parameter for guiding resuscitation efforts utilizes end-tidal carbon dioxide (ETCO 2 ) as an indicator of chest compression efficacy (11). The basis for this method is that the ETCO 2 level during CPR represents the movement of blood containing carbon dioxide to the lungs, and thereby becomes a surrogate for resuscitation-generated systemic blood flow (cardiac output).…”

Rapid assessment of shock in a nonhuman primate model of uncontrolled hemorrhage

“…20 With a proportional relationship to cardiac output, ETCO 2 has been frequently used to monitor hypotensive patients and to gauge the effectiveness of chest compressions following cardiac arrest. [34][35][36][37][38][39] Few studies have evaluated the prognostic capabilities of ETCO 2 in hypovolemic states such as hemorrhagic shock; however, low ETCO 2 values have been associated with high mortality in blunt trauma. 19,21,22,40 Increased circulating lactate has been used in patient risk stratification, and levels greater than 4 mM have been associated with poor outcomes.…”

Exploring the Waveform Characteristics of Tidal Breathing Carbon Dioxide, Measured Using the N-Tidal C Device in Different Breathing Conditions (The General Breathing Record Study): Protocol for an Observational, Longitudinal Study (Preprint)

“…Capnometers have been a standard of care in general anaesthesia for over 30 years and are also widely used in critically unwell patients [13]. Their use is now even recommended to assess adequate cardiopulmonary resuscitation in hospital cardiac arrests [14,15]. However, use is currently limited to these specialist hospital areas in part due to the high cost of capnometers and the requirement for integrated information systems by which data is displayed.…”

“…15.40 Asthma cohort symptoms Asthma patients will report their symptoms 3 times a week (Monday, Wednesday and Friday) via the automated telephone system provided by Message Dynamics. Each participant will be telephoned at a pre-determined, agreed time of day.…”