Expiratory <scp><scp>CO</scp><sub>2</sub></scp> as the first sign of successful ventilation during neonatal resuscitation

Mizumoto, Hiroshi; Iki, Yoichi; Yamashita, S.; Hata, Daisuke

doi:10.1111/ped.12553

Cited by 11 publications

(21 citation statements)

References 7 publications

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“…ECO 2 increases rapidly in the first minute of extrauterine life during spontaneous breathing, but slower if positive pressure ventilation is needed 7–9. Capnography may help identify unfavourable technique and guide ventilations during newborn resuscitation 10–14. There is currently insufficient evidence that ECO 2 monitoring during newborn resuscitation affects outcome 3 15.…”

Section: Introductionmentioning

confidence: 99%

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study

Holte

Ersdal

Eilevstjønn

et al. 2019

bmjpo

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BackgroundExpired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns.MethodsObservational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate <120 beats per minute. We studied ECO2 by clinical factors (birth weight, Apgar scores and initial heart rate) and ventilation factors (expired tidal volume, ventilation frequency, mask leak and inflation pressure) in random intercept models and Cox regression for time to ECO2 >2%.ResultsECO2 rose non-linearly with increasing expired tidal volume up to >10 mL/kg, and sufficient tidal volume was critical for the time to reach ECO2 >2%. Ventilation frequency around 30/min was associated with the highest ECO2. Higher birth weight, Apgar scores and initial heart rate were weak, but significant predictors for higher ECO2. Ventilation factors explained 31% of the variation in ECO2 compared with 11% for clinical factors.ConclusionsOur findings indicate that higher tidal volumes than currently recommended and a low ventilation frequency around 30/min are associated with improved lung aeration during newborn resuscitation. Low ECO2 may be used to identify unfavourable ventilation technique. Clinical factors are also associated with persistently low ECO2 and must be accounted for in the interpretation.

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Section: Introductionmentioning

confidence: 99%

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study

Holte

Ersdal

Eilevstjønn

et al. 2019

bmjpo

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“…In newborns, there were more examples of feasibility and reliability capnography monitoring during CPR. From the 13 studies in these patients (four RCT, nine observational), the vast majority considered capnometric values as a parameter for assessing the quality of ventilation (Table 2), airway patency, mask leaks, and showed a good correlation between capnography and heart rates [19,20,21,22,23,24,25,26,27,28,29,30,31]. The two RCTs that emphasized the validity of the technique were: (1) Hawkes et al, who compared the accuracy of colorimetric detector versus capnography to determine normocarbia, but they did not find a difference in the incidence of normocarbia between the two detectors.…”

Section: Resultsmentioning

confidence: 99%

“…Hooper et al [28] found EtCO 2 levels increased to >10 mmHg in 28 s (median) before the heart rate increased up to 100 bpm. Mizumoto et al [25] found an early detection of expired CO2 (>15 mmHg) between 8 and 73 s (median 15 s) before heart rate improvement. Blank et al [26] indicated that, when the EtCO 2 value was above 14 mmHg (2% in colorimetric detector), the detector showed an accuracy of 95%, detecting an increase in EtCO 2 10 to 20 s before the increase in heart rate appeared on the monitor.…”

Section: Resultsmentioning

confidence: 99%

“…The limitations of the analyzed studies include the designs used, especially the retrospective design of five primary research papers, due to possible bias during data collection with small-sized samples. Otherwise, in newborn studies, the two RCT with larger samples focused on the values of EtCO 2 as another variable observed for assessing the quality of ventilation in two different types of BVM [26] and compared the usual positive pressure ventilation through mask and T-piece device with a sustained ventilation technique, where a correlation was found between high EtCO 2 values and larger volume tidal [25]. The other two RCT focused more on the reliability of capnometry during newborn resuscitation, and reported no improvement or correlation between capnometric values registered and blood PCO 2 levels.…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Capnography with Mask Ventilation during Cardiopulmonary Resuscitation Maneuvers

Cereceda-Sánchez¹,

Molina-Mula

2019

JCM

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The latest guidelines identify capnography as an instrument used to assess bag-valve-mask ventilation during cardiopulmonary resuscitation (CPR). In this review, we analyzed the feasibility and reliability of capnography use with face mask ventilation during CPR maneuvers in adults and children. This systematic review was completed in December 2018; data for the study were obtained from the following databases: EBSCOhost, SCOPUS, PubMed, Índice Bibliográfico Español en Ciencias de la Salud (IBECS), TESEO, and Cochrane Library Plus. Two reviewers independently assessed the eligibility of the articles; we analyzed publications from different sources and identified studies that focused on the use of capnography with a face mask during CPR maneuvers in order to describe the capnometry value and its correlation with resuscitation outcomes and the assistance of professionals. A total of 888 papers were collected, and 17 papers were included that provided objective values for the use of capnography with a mask for ventilation. Four were randomized clinical trials (RCT) and the rest were observational studies. Four studies were completed in adults and 13 were completed in newborns. After the analysis of the papers, we recommended a capnographic level of C in adults and B in newborns. Despite the little evidence obtained, capnography has been demonstrated to facilitate the advanced clinical practice of mask ventilation in cardiopulmonary resuscitation, to be reliable in the early detection of heart rate increase in newborns, and to asses in-airway patency and lung aeration during newborn resuscitation.

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“…10À12 Results from clinical studies in mainly preterm newborns suggest that ECO 2 increases before HR during positive pressure ventilation in the delivery room. 3,13,14 Linde et al found that median ECO 2 in the first minute of bag-mask ventilation (BMV) at birth was lower in newborns who died before 24 h of age compared to survivors. 15 The aims of this study were to explore ECO 2 as a predictor of 24-h outcome (survival vs death) during newborn resuscitation with BMV, and to compare the predictive information of ECO 2 and HR.…”

Section: Introductionmentioning

confidence: 99%

Expired carbon dioxide during newborn resuscitation as predictor of outcome

et al. 2021

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Aim: To explore and compare expired CO 2 (ECO 2 ) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome.Methods: Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO 2 , ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO 2 and HR within three selected time intervals after onset of ventilation (0À30 s, 30.1À60 s and 60.1À300 s).Results: Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO 2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO 2 added extra predictive information compared to HR alone. After 60 s, ECO 2 lost significance when adjusted for HR. In 70% of newborns with initial ECO 2 <2% and HR < 100 bpm, ECO 2 reached !2% before HR ! 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO 2 reached !2% and 44% per minute before HR reached !100 bpm.Conclusions: Higher levels and a faster rise in ECO 2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO 2 increased before HR and may serve as an earlier predictor of survival.

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Expiratory CO₂ as the first sign of successful ventilation during neonatal resuscitation

Cited by 11 publications

References 7 publications

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study

Systematic Review of Capnography with Mask Ventilation during Cardiopulmonary Resuscitation Maneuvers

Expired carbon dioxide during newborn resuscitation as predictor of outcome

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Expiratory CO2 as the first sign of successful ventilation during neonatal resuscitation

Cited by 11 publications

References 7 publications

Predictors for expired CO2 in neonatal bag-mask ventilation at birth: observational study

Predictors for expired CO2 in neonatal bag-mask ventilation at birth: observational study

Systematic Review of Capnography with Mask Ventilation during Cardiopulmonary Resuscitation Maneuvers

Expired carbon dioxide during newborn resuscitation as predictor of outcome

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Expiratory CO₂ as the first sign of successful ventilation during neonatal resuscitation

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study

Predictors for expired CO₂ in neonatal bag-mask ventilation at birth: observational study