Electrical and mechanical recovery of cardiac function following out-of-hospital cardiac arrest

Davis, Daniel P.; Sell, Rebecca; Wilkes, Nathan; Sarno, Renee; Husa, Ruchika; Castillo, Edward M.; Lawrence, Brenna; Fisher, Roger; Brainard, Criss; Dunford, James V.

doi:10.1016/j.resuscitation.2012.07.040

Cited by 21 publications

(8 citation statements)

References 28 publications

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“…Clear indication of return of spontaneous circulation consisted of the absence of chest compressions with a narrow-complex organized rhythm >40 bpm and either a measured blood pressure or clear evidence of a cardiac output component in the impedance signal, synchronous with each ECG complex. 16,17 For determination of the longest nonshock interruption, only interruptions between the beginning of the recording and the delivery of the last shock were considered so that we could avoid potential confounding by interruptions associated with terminating efforts at the end of unsuccessful resuscitation attempts. This also ensured that the longest perishock and nonshock interruptions were measured over the same period of the resuscitation effort.…”

Section: Discussionmentioning

confidence: 99%

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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Background-Minimizing pauses in chest compressions during cardiopulmonary resuscitation is a focus of current guidelines. Prior analyses found that prolonged pauses for defibrillation (perishock pauses) are associated with worse survival. We analyzed resuscitations to characterize the association between pauses for all reasons and both ventricular fibrillation termination and patient survival. Methods and Results-In 319 patients with ventricular tachycardia/fibrillation out-of-hospital cardiac arrest, we analyzed recordings from all defibrillators used during resuscitation and measured durations of all cardiopulmonary resuscitation pauses. Median durations were 32 seconds (25th and 75th percentile, 22 and 52 seconds) for the longest pause for any reason, 23 seconds (25th and 75th percentile, 14 and 34 seconds) for the longest perishock pause, and 24 seconds (25th and 75th percentile, 11 and 38 seconds) for the longest nonshock pause. Multivariable regression models showed lower odds for survival per 5-second increase in the longest overall pause (odds ratio, 0.89; 95% confidence interval, 0.83-0.95), longest perishock pause (odds ratio, 0.85; 95% confidence interval, 0.77-0.93), and longest nonshock pause (odds ratio, 0.83; 95% confidence interval, 0.75-0.91). In 36% of cases, the longest pause was a nonshock pause; this subgroup had lower survival than the group in whom the longest pause was a perishock pause (27% versus 44%, respectively; P<0.01) despite a higher chest compression fraction. Preshock pauses were 8 seconds (25th and 75th percentile, 4 and 17 seconds) for shocks that terminated ventricular fibrillation and 7 seconds (25th and 75th percentile, 4 and 13 seconds) for shocks that did not (P=0.18). Conclusions-Prolonged pauses have a negative association with survival not explained by chest compression fraction or decreased ventricular fibrillation termination rate. Ventricular fibrillation termination was not the mechanism linking pause duration and survival. Strategies shortening the longest pauses may improve outcome.

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Section: Discussionmentioning

confidence: 99%

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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“…with f l = 40 min −1 the lower PR limit, below the bradycardia limit at 50 min −1 [2], and considered a minimum rate predictive of a potential ROSC [9]. If (20) or (21) did not hold, no signal was considered present.…”

Section: ) Signal Presencementioning

confidence: 99%

“…N i was initialized at 3 and incremented by 1 until the PR had been identified or all N pks frequencies had been analyzed. In each iteration, a set of PR candidates {f cnd } was derived from {f i } by selecting the frequencies between 40 min −1 [9] and 250 min −1 [32]. For each PR candidate, three related frequencies were searched for in {f i } and collected in the set {f cnd,rel }: the harmonic f hrm = 2 · f cnd , the sum interaction frequency f sum = f cnd + f cca , and the difference interaction frequency f dif f = |f cnd − f cca |.…”

Section: ) Signal Presencementioning

confidence: 99%

“…Monitoring end-tidal CO 2 [8], [9], invasive blood pressure [10], [11], or central venous oxygen saturation [12] allows for a more objective assessment of ROSC, also during compressions, but requires a secured airway or placement of catheters. Trans-thoracic impedance (TTI) measurements [13]- [15] and near-infrared spectroscopy (NIRS) [16], [17] are non-invasive methods, but TTI is strongly influenced by compressions and NIRS responds slowly upon ROSC.…”

mentioning

confidence: 99%

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Photoplethysmography-Based Algorithm for Detection of Cardiogenic Output During Cardiopulmonary Resuscitation

Wijshoff

Asten

Peeters

et al. 2015

IEEE Trans. Biomed. Eng.

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Detecting return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) is challenging, time consuming, and requires interrupting chest compressions. Based on automated-CPR porcine data, we have developed an algorithm to support ROSC detection, which detects cardiogenic output during chest compressions via a photoplethysmography (PPG) signal. The algorithm can detect palpable and impalpable spontaneous pulses. A compression-free PPG signal which estimates the spontaneous pulse waveform, was obtained by subtracting the compression component, modeled by a harmonic series. The fundamental frequency of this series was the compression rate derived from the transthoracic impedance signal measured between the defibrillation pads. The amplitudes of the harmonic components were obtained via a least mean-square algorithm. The frequency spectrum of the compression-free PPG signal was estimated via an autoregressive model, and the relationship between the spectral peaks was analyzed to identify the pulse rate (PR). Resumed cardiogenic output could also be detected from a decrease in the baseline of the PPG signal, presumably caused by a redistribution of blood volume to the periphery. The algorithm indicated cardiogenic output when a PR or a redistribution of blood volume was detected. The algorithm indicated cardiogenic output with 94% specificity and 69% sensitivity compared to the retrospective ROSC detection of nine clinicians. Results showed that ROSC detection can be supported by combining the compression-free PPG signal with an indicator based on the detected PR and redistribution of blood volume.

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“…They did not provide more capnographic values of resuscitations performed using BVM. Davis et al [33] showed that capnography was performed immediately after starting ventilation with BVM and later on after OTI. The authors suggested that this approach established an appropriate capnography functioning and allowed for the recording of an EtCO 2 reference value before intubation.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Capnography with Mask Ventilation during Cardiopulmonary Resuscitation Maneuvers

Cereceda-Sánchez¹,

Molina-Mula

2019

JCM

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The latest guidelines identify capnography as an instrument used to assess bag-valve-mask ventilation during cardiopulmonary resuscitation (CPR). In this review, we analyzed the feasibility and reliability of capnography use with face mask ventilation during CPR maneuvers in adults and children. This systematic review was completed in December 2018; data for the study were obtained from the following databases: EBSCOhost, SCOPUS, PubMed, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), TESEO, and Cochrane Library Plus. Two reviewers independently assessed the eligibility of the articles; we analyzed publications from different sources and identified studies that focused on the use of capnography with a face mask during CPR maneuvers in order to describe the capnometry value and its correlation with resuscitation outcomes and the assistance of professionals. A total of 888 papers were collected, and 17 papers were included that provided objective values for the use of capnography with a mask for ventilation. Four were randomized clinical trials (RCT) and the rest were observational studies. Four studies were completed in adults and 13 were completed in newborns. After the analysis of the papers, we recommended a capnographic level of C in adults and B in newborns. Despite the little evidence obtained, capnography has been demonstrated to facilitate the advanced clinical practice of mask ventilation in cardiopulmonary resuscitation, to be reliable in the early detection of heart rate increase in newborns, and to asses in-airway patency and lung aeration during newborn resuscitation.

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Electrical and mechanical recovery of cardiac function following out-of-hospital cardiac arrest

Cited by 21 publications

References 28 publications

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Photoplethysmography-Based Algorithm for Detection of Cardiogenic Output During Cardiopulmonary Resuscitation

Systematic Review of Capnography with Mask Ventilation during Cardiopulmonary Resuscitation Maneuvers

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