Stroke volumes and end-tidal carbon dioxide generated by precordial compression during ventricular fibrillation

Pernat, Andrej; Weil, Max Harry; Sun, Shijie; Tang, Wanchun

doi:10.1097/01.ccm.0000069538.12447.82

Cited by 47 publications

(21 citation statements)

References 53 publications

(53 reference statements)

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“…The relationship between CO and partial end-tidal CO 2 pressure (PETCO 2 ) has been known for decades [13,14], so measurement of PETCO 2 has been proposed to confirm the restoration of spontaneous circulation in patients with cardiac arrest [15], but also as a quantitative indicator of hemodynamic effectiveness of precordial compression during cardiopulmonary resuscitation [16]. Moreover, since PETCO 2 is mainly determined by tissue CO 2 production (VCO 2 ), alveolar ventilation and CO (that is, pulmonary blood flow) [17], when stable metabolic conditions are assumed and minute ventilation is kept constant, acute changes in PETCO 2 have been shown to correlate strongly with changes in CO in experimental [18-24] and clinical [25,26] settings.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver

et al. 2012

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BackgroundThe passive leg-raising (PLR) maneuver provides a dynamic assessment of fluid responsiveness inducing a reversible increase in cardiac preload. Since its effects are sudden and transitory, a continuous cardiac output (CO) monitoring is required to appropriately assess the hemodynamic response of PLR. On the other hand, changes in partial end-tidal CO2 pressure (PETCO2) have been demonstrated to be tightly correlated with changes in CO during constant ventilation and stable tissue CO2 production (VCO2). In this study we tested the hypothesis that, assuming a constant VCO2 and under fixed ventilation, PETCO2 can track changes in CO induced by PLR and can be used to predict fluid responsiveness.MethodsThirty-seven mechanically ventilated patients with acute circulatory failure were monitored with the CardioQ-ODM esophageal Doppler. A 2-minutes PLR maneuver was performed. Fluid responsiveness was defined according to CO increase (responders ≥ 15%) after volume expansion.ResultsPLR-induced increases in CO and PETCO2 were strongly correlated (R2 = 0.79; P < 0.0001). The areas under the receiver-operating characteristics (ROC) curve for a PLR-induced increase in CO and PETCO2 (0.97 ± 0.03 SE; CI 95%: 0.85 to 0.99 and 0.94 ± 0.04 SE; CI 95%: 0.82 to 0.99; respectively) were not significantly different. An increase ≥ 5% in PETCO2 or ≥ 12% in CO during PLR predicted fluid responsiveness with a sensitivity of 90.5% (95% CI: 69.9 to 98.8%) and 95.2% (95% CI: 76.2 to 99.9%), respectively, and a specificity of 93.7% (95% CI: 69.8 to 99.8%).ConclusionInduced changes in PETCO2 during a PLR maneuver could be used to track changes in CO for prediction of fluid responsiveness in mechanically ventilated patients with acute circulatory failure, under fixed minute ventilation and assuming a constant tissue CO2 production.

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Section: Introductionmentioning

confidence: 99%

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver

et al. 2012

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“…Until then, several authors had studied the effect of chest compression on ETCO 2 [24][25][26][27]. This non-invasive, indirect, quantitative technique may serve as an indicator of systemic and pulmonary circulation during CPR and can reflect its effect on cardiac output and stroke volume index [28][29][30][31][32].…”

Section: Effectiveness Of Chest Compressionsmentioning

confidence: 99%

A Review of Carbon Dioxide Monitoring During Adult Cardiopulmonary Resuscitation

Pantazopoulos

Xanthos

Pantazopoulos

et al. 2015

Heart, Lung and Circulation

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Although high quality cardiopulmonary resuscitation is one of the most significant factors related to favourable outcome, its quality depends on many components, such as airway management, compression depth and chest recoil, hands-off time, and early defibrillation. The most common way of controlling the resuscitation efforts is monitoring of end-tidal carbon dioxide. The International Liaison Committee on Resuscitation suggests this method both for in-hospital and out-of-hospital cardiac arrest. However, despite the abundant human and animal studies supporting the usefulness of end-tidal carbon dioxide, its optimal values during cardiopulmonary resuscitation remain controversial. In this review, the advantages and effectiveness of end-tidal carbon dioxide during cardiopulmonary resuscitation are discussed and specific target values are suggested based on the available literature.

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“…It has previously been concluded that EtCO 2 correlates well with blood flow and that PLR induces an increase in descending aortic blood flow of at least 10% or in echocardiographic sub-aortic flow of at least 12% [23-26]. In other studies, EtCO 2 has been shown to be quantitatively predictive of stroke volumes [27]. EtCO 2 has also been described as an important value for predicting ROSC and CPR quality [22,28,29].…”

Section: Introductionmentioning

confidence: 99%

Passive leg raise (PLR) during cardiopulmonary (CPR) – a method article on a randomised study of survival in out-of-hospital cardiac arrest (OHCA)

et al. 2014

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BackgroundIt is estimated that about 275,000 inhabitants experience an out-of-hospital cardiac arrest (OHCA) every year in Europe. Survival in out-of-hospital cardiac arrest is relatively low, generally between five per cent and 10%. Being able to explore new methods to improve the relatively low survival rate is vital for people with these conditions. Passive leg raise (PLR) during cardiopulmonary resuscitation (CPR) has been found to improve cardiac preload and blood flow during chest compressions. The aim of our study is to evaluate whether early PLR during CPR also has an impact on one-month survival in sudden and unexpected out-of-hospital cardiac arrest (OHCA).Method/DesignA prospective, randomized, controlled trial in which all patients (≥18 years) receiving out-of hospital CPR are randomized by envelope to be treated with either PLR or in the flat position. The ambulance crew use a special folding stool which allows the legs to be elevated about 20 degrees. Primary end-point: survival to one month. Secondary end-point: survival to hospital admission to one month and to one year with acceptable cerebral performance classification (CPC) 1–2.DiscussionPLR is a simple and fast maneuver. We believe that the greatest benefit with PLR is when performed early in the process, during the first minutes of CPR and before the first defibrillation. To reach power this study need 3000 patients, we hope that this method article will encourage other sites to contact us and take part in our study.Trial registrationClinicalTrials.gov NCT01952197.

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Stroke volumes and end-tidal carbon dioxide generated by precordial compression during ventricular fibrillation

Cited by 47 publications

References 53 publications

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver

A Review of Carbon Dioxide Monitoring During Adult Cardiopulmonary Resuscitation

Passive leg raise (PLR) during cardiopulmonary (CPR) – a method article on a randomised study of survival in out-of-hospital cardiac arrest (OHCA)

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