Effect of one-lung ventilation on end-tidal carbon dioxide during cardiopulmonary resuscitation in a pig model of cardiac arrest

Abstract

Unrecognized endobronchial intubation frequently occurs after emergency intubation. However, no study has evaluated the effect of one-lung ventilation on end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR). We compared the hemodynamic parameters, blood gases, and ETCO2 during one-lung ventilation with those during conventional two-lung ventilation in a pig model of CPR, to determine the effect of the former on ETCO2. A randomized crossover study was conducted in 12 pigs intubated with double-lumen endobronchial tube to achieve lung separation. During CPR, the animals underwent three 5-min ventilation trials based on a randomized crossover design: left-lung, right-lung, or two-lung ventilation. Arterial blood gases were measured at the end of each ventilation trial. Ventilation was provided using the same tidal volume throughout the ventilation trials. Comparison using generalized linear mixed model revealed no significant group effects with respect to aortic pressure, coronary perfusion pressure, and carotid blood flow; however, significant group effect in terms of ETCO2 was found (P < 0.001). In the post hoc analyses, ETCO2 was lower during the right-lung ventilation than during the two-lung (P = 0.006) or left-lung ventilation (P < 0.001). However, no difference in ETCO2 was detected between the left-lung and two-lung ventilations. The partial pressure of arterial carbon dioxide (PaCO2), partial pressure of arterial oxygen (PaO2), and oxygen saturation (SaO2) differed among the three types of ventilation (P = 0.003, P = 0.001, and P = 0.001, respectively). The post hoc analyses revealed a higher PaCO2, lower PaO2, and lower SaO2 during right-lung ventilation than during two-lung or left-lung ventilation. However, the levels of these blood gases did not differ between the left-lung and two-lung ventilations. In a pig model of CPR, ETCO2 was significantly lower during right-lung ventilation than during two-lung ventilation. However, interestingly, ETCO2 during left-lung ventilation was comparable to that during two-lung ventilation.

Pralidoxime administered during cardiopulmonary resuscitation facilitates successful resuscitation in a pig model of cardiac arrest

“…In our experience, 20% of an animal's anteroposterior chest diameter was the maximum chest compression depth for avoiding critical injuries related to CPR. Hence, this depth was used as optimal chest compression depth in our previous studies using a swine model of CPR . During CPR, asynchronous positive‐pressure ventilations with high‐flow oxygen (15 L/min) were provided at a rate of 10 breaths/min using a volume‐marked manual resuscitator bag .…”

“…Hence, this depth was used as optimal chest compression depth in our previous studies using a swine model of CPR. 26,27 During CPR, asynchronous positive-pressure ventilations with high-flow oxygen (15 L/min) were provided at a rate of 10 breaths/min using a volume-marked manual resuscitator bag. 28 Coinciding with the start of chest compressions, either a saline placebo (control group) or pralidoxime solution (pralidoxime group) was administered into the RA.…”

Femoral artery collapse ratio as an indicator of chest compression quality during cardiopulmonary resuscitation in a porcine cardiac arrest model

“…Several studies have been conducted on ETCO 2 during CPR in animal models. In one study, ETCO 2 was significantly lower during right lung ventilation than during ventilation of both the lungs and ventilation of the left lung [12]. Another study reported that ETCO 2 during extracorporeal cardiopulmonary resuscitation may be predictive of the extent of brain or kidney damage [13,14].…”

Use of Electronic Auscultation in Full Personal Protective Equipment to Detect Ventilation Status in Selective Lung Ventilation: A Randomized Controlled Trial

“…However, maintenance of adequate vision during intubation can be challenging for clinicians, particularly in high-tension environments and with the physical barriers of PPE. In addition, instant capnography check does not guarantee the avoidance of endobronchial intubation ( 14 – 16 ). For instance, hypoxemia may occur later, ( 15 ) and capnography measurements may not change in endobronchial intubation ( 14 , 16 ).…”

“…In addition, instant capnography check does not guarantee the avoidance of endobronchial intubation ( 14 – 16 ). For instance, hypoxemia may occur later, ( 15 ) and capnography measurements may not change in endobronchial intubation ( 14 , 16 ). Nevertheless, our results indicated that most of the auscultation test failures (76.9%) occurred because the participant anesthesiologist was unable to confirm bilateral symmetric lung sound, regardless of the auscultation method.…”