Untitled

Grmec, Štefek; Lah, Katja; Tušek-Bunc, Ksenija

doi:10.1186/cc2369

Cited by 94 publications

(25 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The ETCO 2 in the standard and ETCO 2 groups fell to 25 and 32 mmHg, respectively, at 1 minute of CPR, a range that was useful and persisted during the remainder of resuscitation. Others have also reported a similar rapid decrease in ETCO 2 after asphyxial arrest (33, 34). Another potential confounder of ETCO 2 -guided CPR is that epinephrine administration might affect pulmonary blood flow and ETCO 2 levels.…”

Section: Discussionsupporting

confidence: 52%

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

Hamrick

Bhalala³

et al. 2017

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective To determine whether end-tidal carbon dioxide (ETCO2)-guided chest compression delivery improves survival over standard cardiopulmonary resuscitation (CPR) after prolonged asphyxial arrest. Design Preclinical randomized controlled study. Setting University animal research laboratory. Subjects 1–2-week-old swine. Interventions After undergoing a 20-minute asphyxial arrest, animals received either standard or ETCO2-guided CPR. In the standard group, chest compression delivery was optimized by video and verbal feedback to maintain the rate, depth, and release within published guidelines. In the ETCO2-guided group, chest compression rate and depth were adjusted to obtain a maximal ETCO2 level without other feedback. CPR included 10 minutes of basic life support followed by advanced life support for 10 minutes or until return of spontaneous circulation (ROSC). Measurements and Main Results Mean ETCO2 at 10 minutes of CPR was 34 ± 8 torr in the ETCO2 group (n=14) and 19 ± 9 torr in the standard group (n=14; p=0.0001). The ROSC rate was 7/14 (50%) in the ETCO2 group and 2/14 (14%) in the standard group (p=0.04). The chest compression rate averaged 143 ± 10/minute in the ETCO2 group and 102 ± 2/minute in the standard group (p<0.0001). Neither asphyxia-related hypercarbia nor epinephrine administration confounded the use of ETCO2-guided chest compression delivery. The response of the relaxation arterial pressure and cerebral perfusion pressure to the initial epinephrine administration was greater in the ETCO2 group than in the standard group (p=0.01 and p=0.03, respectively). The prevalence of resuscitation-related injuries was similar between groups. Conclusions ETCO2-guided chest compression delivery is an effective resuscitation method that improves early survival after prolonged asphyxial arrest in this neonatal piglet model. Optimizing ETCO2 levels during CPR required that chest compression delivery rate exceed current guidelines. The use of physiologic feedback during CPR has the potential to provide optimized and individualized resuscitative efforts.

show abstract

Section: Discussionsupporting

confidence: 52%

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

Hamrick

Bhalala³

et al. 2017

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…However, to minimize this bias, our predictor variables (ETCO 2 and hemodynamics) were acquired 8 minutes into CPR, long after the time period when these values would equilibrate between injury groups. 21,41 Third, while the AUC for DBP (0.82) was significantly superior to that of ETCO 2 (0.60), the reader should note that it is an imperfect predictor of survival. Caution should be applied in using DBP as a standalone predictor of survival or as an indication to cease resuscitation efforts.…”

Section: Discussionmentioning

confidence: 96%

A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide

et al. 2016

View full text Add to dashboard Cite

Aim The American Heart Association (AHA) recommends monitoring invasive arterial diastolic blood pressure (DBP) and end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) when available. In intensive care unit patients, both may be available to the rescuer. The objective of this study was to compare DBP versus ETCO2 during CPR as predictors of cardiac arrest survival. Methods In two models of cardiac arrest (primary ventricular fibrillation [VF] and asphyxia-associated VF), 3-month old swine received either standard AHA guideline-based CPR or patient-centric, BP-guided CPR. Mean values of DBP and ETCO2 in the final two minutes before the first defibrillation attempt were compared using receiver operating characteristic curves (area under curve [AUC] analysis). The optimal DBP cut point to predict survival was derived and subsequently validated in two independent, randomly generated cohorts. Results Of 60 animals, 37 (61.7%) survived to 45 minutes. DBP was higher in survivors than in non-survivors (40.6±1.8mmHg vs. 25.9±2.4mmHg; p<0.001), while ETCO2 was not different (30.0±1.5mmHg vs. 32.5±1.8mmHg; p=0.30). By AUC analysis, DBP was superior to ETCO2 (0.82 vs. 0.60; p=0.025) in discriminating survivors from non-survivors. The optimal DBP cut point in the derivation cohort was 34.1mmHg. In the validation cohort, this cut point demonstrated a sensitivity of 0.78, specificity of 0.81, positive predictive value of 0.64, and negative predictive value of 0.89 for survival. Conclusions In both primary and asphyxia-associated VF porcine models of cardiac arrest, DBP discriminates survivors from non-survivors better than ETCO2. Failure to attain a DBP >34mmHg during CPR is highly predictive of non-survival.

show abstract

“…During CPR, ETCO 2 values are low, reflecting the low CO generated by chest compression. Although ETCO 2 values higher than 10 mm Hg have been correlated to ROSC, [85][86][87][88][89] there is uncertainty if any ETCO 2 value measured during CPR can reliably predict survival or survival with good neurologic outcome.…”

Section: Physiological Monitoring During Cprmentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

View full text Add to dashboard Cite

Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

show abstract

Untitled

Abstract: Correspondence: Katja Lah, katkalah@email.si R139 CPR = cardiopulmonary resuscitation; PetCO 2 = partial pressure of end-tidal carbon dioxide; ROSC = return of spontaneous circulation; VF = ventricular fibrillation; VT = ventricular tachycardia. Abstract

Cited by 94 publications

References 26 publications

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

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

A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide

Part 4: Advanced Life Support

Contact Info

Product

Resources

About