Monitoring the quality of cardiopulmonary resuscitation

Morley, Peter

doi:10.1097/mcc.0b013e32814b05bd

Cited by 22 publications

(10 citation statements)

References 76 publications

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“…On the contrary, it can now be a helpful tool to estimate the changes in cardiac function. Evidently, ETCO 2 monitoring is successfully used in evaluating the effectiveness of the thrombolytic treatment of pulmonary embolism [5] and also is good for evaluating the effectiveness of CPR [7,8]. Our results suggest that it can be used to predict the change in cardiac output during liver transplantation, when cardiac output measurement is not available.…”

Section: Discussionmentioning

confidence: 70%

Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation

Shih

Huang

Chen

et al. 2016

Transplantation Proceedings

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Section: Discussionmentioning

confidence: 70%

Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation

Shih

Huang

Chen

et al. 2016

Transplantation Proceedings

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“…Although we attempted to evaluate concordance among event reviewers, we lack a precise mechanism to determine the true ventilation rate. In the future, alternative mechanisms to monitor the ventilation rate, such as capnography (End-tidal CO 2 ) or airway pressure 14,29 will be utilized. Alternatively, additional information about our existing data set could be gleaned from review of either audio or video transcripts.…”

Section: Discussionmentioning

confidence: 99%

The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents

et al. 2011

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Aim During adult cardiac arrest, rescuers frequently provide ventilations at rates exceeding those recommended by the American Heart Association (AHA). Excessive ventilation is associated with worse clinical outcome after adult cardiac arrest. This study is the first to characterize ventilation rate adherence to AHA guidelines during in-hospital pediatric cardiac arrest resuscitation. Patients and methods We prospectively enrolled children and adolescents (≥8 years of age) who suffered a cardiac arrest in a pediatric intensive care unit (PICU) or emergency department (ED) of a tertiary-care pediatric hospital. Ventilation rate (breaths per minute [bpm]) was monitored via changes in chest wall impedance (CWI) recorded by defibrillator electrode pads during cardiopulmonary resuscitation (CPR). Results Twenty-four CPR events were enrolled yielding 588 thirty-second CPR epochs. The proportion of CPR epochs with ventilation rates exceeding AHA guidelines (>10 bpm) was 63% (CI95 59–67%), significantly higher than our a priori hypothesis of 30% (p < 0.01). The proportion of CPR epochs with ventilation rates exceeding 20 bpm was 20% (CI95 17–23). After controlling for location of arrest and initial event rhythm, resuscitations that occurred on nights/weekends were 3.6 times (CI95: 1.6–7.9, p < 0.01) more likely to have a ventilation rate exceeding AHA guidelines. Conclusions During in-hospital pediatric cardiac arrest, rescuers frequently provide artificial ventilations at rates in excess of AHA guidelines, with twenty percent of CPR time having ventilation rates double that recommended. Excessive ventilation was particularly common during CPR events that occurred on nights/weekends.

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“…The recording of CPR quality parameters, such as ventilation rate, has become clinically available through a variety of devices including both CPR-sensing defibrillators and free-standing measurement tools 13. Measurement of chest compression parameters, such as rate and depth, can be measured via chest wall force transducers and/or accelerometers placed under the hands of a rescuer performing compressions; this method has been widely applied in a number of studies 1, 14–17 .…”

Section: Discussionmentioning

confidence: 99%

“…13 Airway pressure detection is currently employed in respiratory profile monitors, and could also be incorporated into defibrillators or resuscitation ventilation equipment. We speculate that the rate of ventilations might be most reliably measured using airway pressure, but this remains to be investigated during the clinical delivery of CPR.…”

Section: Discussionmentioning

confidence: 99%

Capnography and chest-wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation

et al. 2010

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Objective-Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches.Methods-Continuous chest wall impedance and capnography were recorded during consecutive in-hospital cardiac arrests. Algorithms utilizing each of these data sources were compared to a manually determined "gold standard" reference ventilation rate. In addition, a combination algorithm, which utilized the highest of the impedance or capnography values in any given minute, was similarly evaluated.Results-Data were collected from 37 cardiac arrests, yielding 438 min of data with continuous chest compressions and concurrent recording of impedance and capnography. The manually calculated mean ventilation rate was 13.3±4.3/min. In comparison, the defibrillator's impedancebased algorithm yielded an average rate of 11.3±4.4/min (p=0.0001) while the capnography rate was 11.7±3.7/min (p=0.0009). There was no significant difference in sensitivity and positive predictive value between the two methods. The combination algorithm rate was 12.4±3.5/min (p=0.02), which yielded the highest fraction of minutes with respiratory rates within 2/min of the reference. The Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation. Conflict of Interest

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Monitoring the quality of cardiopulmonary resuscitation

Cited by 22 publications

References 76 publications

Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation

Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation

The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents

Capnography and chest-wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation

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