End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest

Savastano, Simone; Baldi, Enrico; Raimondi, Maurizio; Palo, Alessandra; Belliato, Mirko; Cacciatore, Elisa; Corazza, Valentina; Molinari, Simone; Canevari, Fabrizio; Danza, Aurora Ilaria; Ferrari, Gaetano M. De; Iotti, Giorgio; Visconti, Luigi Oltrona

doi:10.1016/j.resuscitation.2017.09.010

Cited by 23 publications

(19 citation statements)

References 30 publications

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“…First shocks with MEtCO 2 values under 11 mmHg (n=10) were always unsuccessful, while 60% were successful for MEtCO 2 above 40 mmHg (n=22). Our low MEtCO 2 cutoff for unsuccessful shocks is similar to the values observed by Savastano et al [29], and confirm an MEtCO 2 value around 10 mmHg may be used as an indication to delay the shock. These findings are aligned with the European [19] and American [40] guidelines which suggest 10 mmHg as an indicator of good quality CPR.…”

Section: Discussionsupporting

confidence: 90%

“…Shock success was defined as the appearence of sustained QRS complexes with a rate above 40 beats/min within 60-seconds after the shock [16]. The appearence of sustained QRS complexes after the shock has been a widely accepted criterion for the definition of shock success in many previous studies [8,[29][30][31][32][33]. Figure 1 shows two representative examples.…”

Section: Data Materialsmentioning

confidence: 99%

“…Higher EtCO 2 has been linked to shock success in animal models [20], and positive correlations between AMSA and EtCO 2 have been found in animal data [27] and during a prolonged case of refractory VF in OHCA [28]. Although the evidence is not conclusive, the mean EtCO 2 in the minute preceding defibrillation is associated to defibrillation success [29], and the accuracy of defibrillation success prediction may be increased by combining EtCO 2 and VF-waveform features [30].…”

Section: Introductionmentioning

confidence: 99%

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Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest

et al. 2019

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Background and aim: Unsuccessful defibrillation shocks adversely affect survival from out-ofhospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-ofchoice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO 2 (EtCO 2) could improve the prediction. The aim of this study was to evaluate EtCO 2 as predictor of shock success, both individually and in combination with VF-waveform analysis. Materials and methods: In total 514 shocks from 214 OHCA patients (75 first shocks) were analysed. For each shock three predictors of defibrillation success were automatically calculated from the device files: two VF-waveform features, amplitude spectrum area (AMSA) and fuzzy entropy (FuzzyEn), and the median EtCO 2 (MEtCO 2) in the minute before the shock. Sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated, for each predictor individually and for the combination of MEtCO 2 and VF-waveform predictors. Separate analyses were done for first shocks and all shocks. Results: MEtCO 2 in first shocks was significantly higher for successful than for unsuccessful shocks (31 mmHg/25 mmHg, p<0.05), but differences were not significant for all shocks (32 mmHg/29 mmHg, p>0.05). MEtCO 2 predicted shock success with an AUC of 0.66 for first shocks, but was not a predictor for all shocks (AUC 0.54). AMSA and FuzzyEn presented AUCs of 0.76 and 0.77 for first shocks, and 0.75 and 0.75 for all shocks. For first shocks, adding MEtCO 2 improved the AUC of AMSA and FuzzyEn to 0.79 and 0.83, respectively. Conclusions: MEtCO 2 predicted defibrillation success only for first shocks. Adding MEtCO 2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform

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Section: Discussionsupporting

confidence: 90%

Section: Data Materialsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest

et al. 2019

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“…Hemodynamic monitoring during cardiopulmonary resuscitation (CPR) helps to maintain high quality. A retrospective study reported recently that the higher the end-tidal carbon dioxide (ETCO2) was prior to the shock, the higher the chance of success [1]. In another study the Amplitude Spectrum Area (AMSA) of 17 mV-Hz predicted defibrillation success in two thirds of cases [2].…”

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confidence: 99%

Variation and correlation of end–tidal CO2 and amplitude spectrum area in a refractory ventricular fibrillation. A case from the ReCaPTa study

et al. 2018

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“… Helps guide chest compression quality. A recent study suggests an association between high-quality chest compressions with a higher ETCO 2 and defibrillation success after OHCA [ 38 ]. Helps identify ROSC during CPR.…”

Section: The Role Of Waveform Capnography During Cpr and After Roscmentioning

confidence: 99%

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

2018

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After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults. Current evidence supports a stepwise approach to airway management based on patient factors, rescuer skills and the stage of resuscitation. During CPR, rescuers should provide the maximum feasible inspired oxygen and use waveform capnography once an advanced airway is in place. After ROSC, rescuers should titrate inspired oxygen and ventilation to achieve normal oxygen and carbon dioxide targets.

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End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest

Cited by 23 publications

References 30 publications

Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest

Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest

Variation and correlation of end–tidal CO2 and amplitude spectrum area in a refractory ventricular fibrillation. A case from the ReCaPTa study

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

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