Association between Prehospital CPR Quality and End-Tidal Carbon Dioxide Levels in Out-of-Hospital Cardiac Arrest

Murphy, Ryan Anne; Bobrow, Bentley J.; Spaite, Daniel W.; Hu, Chengcheng; McDannold, Robyn; Vadeboncoeur, Tyler

doi:10.3109/10903127.2015.1115929

Cited by 50 publications

(29 citation statements)

References 32 publications

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“…The association between log-transformed ETCO 2 and CPR variables was assessed through linear mixed effect models. The authors concluded that a 10 mm increase in compression depth was associated with a 4.0% increase in ETCO 2 (p < 0.0001); a 10 vpm increase in ventilation rate with a 17.4% decrease in ETCO 2 (p < 0.0001); and a 10 cpm increase in compression rate with a 1.7% increase in ETCO 2 (p = 0.02) [15].…”

Section: Discussionmentioning

confidence: 97%

“…Two recent studies have investigated these relationships [14,15]. Sheak et al conducted a multicenter cohort study of 583 in-hospital and out-of-hospital cardiac arrests.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, for every 10 mm increase in depth, ETCO 2 rose 1.4 mmHg (p < 0.001); for every 10 vpm increase in ventilation rate, ETCO 2 dropped 3.0 mmHg (p < 0.001); and compression rate was not a predictor of ETCO 2 variation. Murphy et al conducted an observational prospective study with similar objectives including 230 patients [15]. In this case, ETCO 2 level, chest compression data and ventilation rate were averaged over 1-min epochs.…”

Section: Discussionmentioning

confidence: 99%

“…Waveform capnography, i.e., continuous measurement of CO 2 concentration with time, enables monitoring of ETCO 2 during CPR. Current advanced life support (ALS) resuscitation guidelines [12,13] emphasize the potential role of waveform capnography in monitoring CPR quality [14,15], in the early recognition of return of spontaneous circulation (ROSC) during CPR [16,17], and as a potential indicator of patient outcome [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have modeled the influence of chest compression quality (compression depth and rate) and ventilation rate on ETCO 2 during CPR using multivariate analysis [14,15]. Studies on ROSC detection and patient outcome rely on the comparison of measured ETCO 2 levels [16][17][18][19][20]24].…”

Section: Introductionmentioning

confidence: 99%

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Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

et al. 2020

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Aim Current resuscitation guidelines recommend waveform capnography as an indirect indicator of perfusion during cardiopulmonary resuscitation (CPR). Chest compressions (CCs) and ventilations during CPR have opposing effects on the exhaled carbon dioxide (CO 2) concentration, which need to be better characterized. The purpose of this study was to model the impact of ventilations in the exhaled CO 2 measured from capnograms collected during outof-hospital cardiac arrest (OHCA) resuscitation. Methods We retrospectively analyzed OHCA monitor-defibrillator files with concurrent capnogram, compression depth, transthoracic impedance and ECG signals. Segments with CC pauses, two or more ventilations, and with no pulse-generating rhythm were selected. Thus, only ventilations should have caused the decrease in CO 2 concentration. The variation in the exhaled CO 2 concentration with each ventilation was modeled with an exponential decay function using non-linear-least-squares curve fitting. Results Out of the original 1002 OHCA dataset (one per patient), 377 episodes had the required signals, and 196 segments from 96 patients met the inclusion criteria. Airway type was endotracheal tube in 64.8% of the segments, supraglottic King LT-D™ in 30.1%, and unknown in 5.1%. Median (IQR) decay factor of the exhaled CO 2 concentration was 10.0% (7.8 − 12.9) with R 2 = 0.98(0.95 − 0.99). Differences in decay factor with airway type were not statistically significant (p = 0.17). From these results, we propose a model for estimating the contribution of CCs to the end-tidal CO 2 level between consecutive ventilations and for estimating the end-tidal CO 2 variation as a function of ventilation rate.

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Section: Discussionmentioning

confidence: 97%

“…Two recent studies have investigated these relationships [14,15]. Sheak et al conducted a multicenter cohort study of 583 in-hospital and out-of-hospital cardiac arrests.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

et al. 2020

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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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Airway and Ventilation During Cardiopulmonary Resuscitation

Gough

Nolan

2017

Annual Update in Intensive Care and Emergency Medicine

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Association between Prehospital CPR Quality and End-Tidal Carbon Dioxide Levels in Out-of-Hospital Cardiac Arrest

Cited by 50 publications

References 32 publications

Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest

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

Airway and Ventilation During Cardiopulmonary Resuscitation

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