Transthoracic impedance used to evaluate performance of cardiopulmonary resuscitation during out of hospital cardiac arrest

Stecher, Frederik S.; Olsen, Jan-Aage; Stickney, Ronald E.; Wik, Lars

doi:10.1016/j.resuscitation.2008.08.007

Cited by 86 publications

(57 citation statements)

References 13 publications

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“…The 10 studies included 8 prospective cohort studies [12][13][14][18][19][20]24,25 and 2 post hoc analyses of clinical trials (the Table). 17,26 Seven studies were conducted in North America [12][13][14]18,20,24,25 and 3 in Europe.…”

Section: Resultsmentioning

confidence: 99%

“…17,26 Seven studies were conducted in North America [12][13][14]18,20,24,25 and 3 in Europe. 17,19,26 Data on chest compression rate were available for 1641 patients (176 IHCA and 1465 OHCA); data on depth were available for 1892 patients (77 IHCA and 1815 OHCA); data on no-flow fraction were available for 3424 patients (79 IHCA and 3345 OHCA); and data on ventilation rate were available for 483 patients (71 IHCA and 412 OHCA). No randomized, controlled trials of manual CPR quality and survival were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies quantifying rate, depth, no-flow fraction, and ventilation rate [12][13][14][17][18][19][20]25,26 did so using an investigational monitor/defibrillator with accelerometer, force detector, and chest wall impedance detector; however, 1 investigation 24 used customized personal digital assistant software controlled by a research assistant to collect compression rate data. The total number of patients varied substantially between studies (n=49-2103).…”

Section: Resultsmentioning

confidence: 99%

“…15,16 For 7 of the 10 included studies, authors were directly contacted to request missing or additional data. Six study authors [12][13][14][17][18][19] were asked to provide summary statistics for continuous CPR quality variables stratified by survival outcome so that a mean difference could be computed. A seventh study 20 included both IHCA and OHCA events; the author was asked to provide separate estimates for each group to allow stratification by cardiac arrest location.…”

Section: Data Extractionmentioning

confidence: 99%

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Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest Outcome

Wallace

Abella

Becker

2013

Circ: Cardiovascular Quality and Outcomes

103

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Background-Evidence has accrued that cardiopulmonary resuscitation quality affects cardiac arrest outcome. However, the relative contributions of chest compression components (such as rate and depth) to successful resuscitation remain unclear.Methods and Results-We sought to measure the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome through systematic review and meta-analysis. We searched for any clinical study assessing cardiopulmonary resuscitation performance on adult cardiac arrest patients in which survival was a reported outcome, either return of spontaneous circulation or survival to admission or discharge. Of 603 identified abstracts, 10 studies met inclusion criteria. Effect sizes were reported as mean differences. Missing data were resolved by author contact. Estimates were segregated by cardiopulmonary resuscitation metric (chest compression rate, depth, no-flow fraction, and ventilation rate), and a random-effects model was applied to estimate an overall pooled effect. Arrest survivors were significantly more likely to have received deeper chest compressions than nonsurvivors (mean difference, 2.44 mm; 95% confidence interval, 1.19-3.69 [P<0.001]; n=6 studies; I 2 =0.0%; P for heterogeneity=0.9). Likewise, survivors were significantly more likely to have received chest compression rates closer to 85 to 100 compressions per minute (cpm) than nonsurvivors (absolute mean difference from 85 cpm, −4.81 cpm; 95% confidence interval, −8.19 to −1.43 [P=0.005]; from 100 cpm, −5.04 cpm; 95% confidence interval, −8.44 to −1.65 [P=0.004]; n=6 studies; I 2 <49%; P for heterogeneity >0.2). No significant difference in no-flow fraction (n=7 studies) or ventilation rate (n=4 studies) was detected between survivors and nonsurvivors. Conclusions-Deeper

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Data Extractionmentioning

confidence: 99%

See 2 more Smart Citations

Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest Outcome

Wallace

Abella

Becker

2013

Circ: Cardiovascular Quality and Outcomes

103

View full text Add to dashboard Cite

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“…13 The start of CPR after the shock was visible through the impedance signal of the recording. 14 If the start of CPR after the shock could not be determined from the impedance signal recorded by the AED, the patient was also excluded from the analysis.…”

Section: Design Of Current Analysismentioning

confidence: 99%

Chest Compressions Cause Recurrence of Ventricular Fibrillation After the First Successful Conversion by Defibrillation in Out-of-Hospital Cardiac Arrest

Berdowski

Tijssen

Koster

2010

Circ: Arrhythmia and Electrophysiology

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Background— Unlike Resuscitation Guidelines (GL) 2000, GL2005 advise resuming cardiopulmonary resuscitation (CPR) immediately after defibrillation. We hypothesized that immediate CPR resumption promotes earlier recurrence of ventricular fibrillation (VF). Methods and Results— This study used data of a prospective per-patient randomized controlled trial. Automated external defibrillators used by first responders were randomized to either (1) perform postshock analysis and prompt rescuers to a pulse check (GL2000), or (2) resume CPR immediately after defibrillation (GL2005). Continuous recordings of ECG and impedance signals were collected from all patients with an out-of-hospital cardiac arrest to whom a randomized automated external defibrillator was applied. We included patients with VF as their initial rhythm in whom CPR onset could be determined from the ECG and impedance signals. Time intervals are presented as median (Q1-to-Q3). Of 361 patients, 136 met the inclusion criteria: 68 were randomly assigned to GL2000 and 68 to GL2005. Rescuers resumed CPR 30 (21-to-39) and 8 (7-to-9) seconds, respectively, after the first shock that successfully terminated VF ( P <0.001); VF recurred after 40 (21-to-76) and 21 (10-to-80) seconds, respectively ( P =0.001). The time interval between start of CPR and VF recurrence was 6 (0-to-67) and 8 (3-to-61) seconds, respectively ( P =0.88). The hazard ratio for VF recurrence in the first 2 seconds of CPR was 15.5 (95% confidence interval, 5.63 to 57.7) compared with before CPR resumption. After more than 8 seconds of CPR, the hazard of VF recurrence was similar to before CPR resumption. Conclusions— Early CPR resumption after defibrillation causes early VF recurrence. Clinical Trial Registration— clinicaltrials.gov Identifier: ISRCTN72257677.

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A review of ventilation in adult out‐of‐hospital cardiac arrest

et al. 2020

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Out‐of‐hospital cardiac arrest continues to be a devastating condition despite advances in resuscitation care. Ensuring effective gas exchange must be weighed against the negative impact hyperventilation can have on cardiac physiology and survival. The goals of this narrative review are to evaluate the available evidence regarding the role of ventilation in out‐of‐hospital cardiac arrest resuscitation and to provide recommendations for future directions. Ensuring successful airway patency is fundamental for effective ventilation. The airway management approach should be based on professional skill level and the situation faced by rescuers. Evidence has explored the influence of different ventilation rates, tidal volumes, and strategies during out‐of‐hospital cardiac arrest; however, other modifiable factors affecting out‐of‐hospital cardiac arrest ventilation have limited supporting data. Researchers have begun to explore the impact of ventilation in adult out‐of‐hospital cardiac arrest outcomes, further stressing its importance in cardiac arrest resuscitation management. Capnography and thoracic impedance signals are used to measure ventilation rate, although these strategies have limitations. Existing technology fails to reliably measure real‐time clinical ventilation data, thereby limiting the ability to investigate optimal ventilation management. An essential step in advancing cardiac arrest care will be to develop techniques to accurately and reliably measure ventilation parameters. These devices should allow for immediate feedback for out‐of‐hospital practitioners, in a similar way to chest compression feedback. Once developed, new strategies can be established to guide out‐of‐hospital personnel on optimal ventilation practices.

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Transthoracic impedance used to evaluate performance of cardiopulmonary resuscitation during out of hospital cardiac arrest

Cited by 86 publications

References 13 publications

Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest Outcome

Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest Outcome

Chest Compressions Cause Recurrence of Ventricular Fibrillation After the First Successful Conversion by Defibrillation in Out-of-Hospital Cardiac Arrest

A review of ventilation in adult out‐of‐hospital cardiac arrest

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