Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model

Abstract

To investigate the use of two-site regional oxygen saturations (rSO 2) and end tidal carbon dioxide (EtCO 2) to assess the effectiveness of resuscitation and return of spontaneous circulation (ROSC). Eight mechanically ventilated juvenile swine underwent 28 ventricular fibrillatory arrests with open cardiac massage. Cardiac massage was administered to achieve target pulmonary blood flow (PBF) as a percentage of pre-cardiac arrest baseline. Non-invasive data, including, EtCO 2 , cerebral rSO 2 (C-rSO 2) and renal rSO 2 (R-rSO 2) were collected continuously. Our data demonstrate the ability to measure both rSO 2 and EtCO 2 during CPR and after ROSC. During resuscitation EtCO 2 had a strong correlation with goal CO with r = 0.83 (p < 0.001) 95% CI [0.67-0.92]. Both C-rSO 2 and R-rSO 2 had moderate and statistically significant correlation with CO with r = 0.52 (p = 0.003) 95% CI (0.19-0.74) and 0.50 (p = 0.004) 95% CI [0.16-0.73]. The AUCs for sudden increase of EtCO 2 , C-rSO 2 , and R-rSO 2 at ROSC were 0.86 [95% CI, 0.77-0.94], 0.87 [95% CI, 0.8-0.94], and 0.98 [95% CI, 0.96-1.00] respectively. Measurement of continuous EtCO 2 and rSO 2 may be used during CPR to ensure effective chest compressions. Moreover, both rSO 2 and EtCO 2 may be used to detect ROSC in a swine pediatric ventricular fibrillatory arrest model.

Volumetric capnography and return of spontaneous circulation in an experimental model of pediatric asphyxial cardiac arrest

“…Some authors suggested that VCO 2 and VCO 2 /kg were also good predictors of ROSC 17 , 20 , 21 , although these parameters did not demonstrate utility for this purpose in our study. Most of these studies induced a ventricular-fibrillation cardiac arrest.…”

Prediction of return of spontaneous circulation during cardiopulmonary resuscitation by pulse-wave cerebral tissue oxygen saturation: a retrospective observational study

“…Cerebral tissue oxygen saturation during CPR is greater in patients with ROSC than in those without [ 3 – 7 , 11 ]. Furthermore, cerebral tissue oxygen saturation during CPR is correlated with cardiac output [ 16 ]. This may imply that the increase in cardiac output, as generated by high-quality CPR, may increase systemic organ perfusion, systemic oxygenation, pulmonary perfusion, and cerebral tissue oxygen saturation, leading to the achievement of ROSC combined with improved coronary perfusion and oxygenation [ 17 ].…”

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

“…Planned secondary analysis was performed on data collected in a previous study that investigated the use of two-site regional oxygen saturations and EtCO 2 to assess the effectiveness of resuscitation and identify ROSC in a swine VF cardiac arrest model. 21 The initial study protocol was approved by The University of Wisconsin Institutional Animal Care and Use Committee, as per the guidelines in the United States Department of Health and Human Services and the National Institutes for Health.…”