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

Azeli, Youcef; Herrero, Joan; Fortuny, Gerard; Puigjaner, Dolors; López, Josep M.; Puig, Anna Borrell de; Jiménez-Fàbrega, Xavier; Bardajı́, Alfredo

doi:10.1016/j.resuscitation.2017.11.049

Cited by 4 publications

(3 citation statements)

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“…The effect of gravity may impair venous drainage from the brain to the heart and increase intracranial pressure in the case of CPR in Trendelenburg position [38]. A higher but no significant survival rate at hospital admission was found in our study in favor of PLR among patients with a shockable rhythm, suggesting that PLR may be useful in optimizing the conditions prior to an attempt of defibrillation during hemodynamically guided CPR [39,40]. It should be considered that the greatest change in cardiac output due to PLR occurs after 1 min of the procedure [14].…”

Section: Discussioncontrasting

confidence: 56%

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

et al. 2021

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Background There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA). Methods We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1–2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors. Results In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60–82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1–2 (OR 0.9; 95% CI 0.4–2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7–1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8–3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909–1500) vs 1239 mg (IQR 900–1507), p = 0.82] or brain weight [1352 mg (IQR 1227–1457) vs 1380 mg (IQR 1255–1470), p = 0.43] among the 106 autopsies performed. Conclusion In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1–2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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Section: Discussioncontrasting

confidence: 56%

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

et al. 2021

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“…Abrupt increments of EtCO 2 and higher values of EtCO 2 have been associated with restoration of spontaneous circulation, quality of CPR and patient outcome [21][22][23][24][25][26]. 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: 95%

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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“…Early and uninterrupted CPR, together with early defibrillation, is critical for a successful outcome after cardiac arrest. A recent study further confirmed that the analysis of real-time variations and trends of ECG features could help in selecting the timing of defibrillation to avoid unnecessary shocks and improve outcomes in extended cases of refractory VF (27). However, the CCproduced artifact modifies the underlying ECG and precludes reliable waveform analysis, either for shockable rhythm identification or for determining the probability of defibrillation success evaluation (20).…”

Section: Discussionmentioning

confidence: 96%

Estimating the amplitude spectrum area of ventricular fibrillation during cardiopulmonary resuscitation using only ECG waveform

Feng¹,

Ding²,

Dai³

et al. 2021

Ann Transl Med

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Background: Amplitude spectrum area (AMSA) calculated from ventricular fibrillation (VF) can be used to monitor the effectiveness of chest compression (CC) and optimize the timing of defibrillation.However, reliable AMSA can only be obtained during CC pause because of artifacts. In this study, we sought to develop a method for estimating AMSA during cardiopulmonary resuscitation (CPR) using only the electrocardiogram (ECG) waveform.Methods: Intervals of 8 seconds ECG and CC-related references, including 4 seconds during CC and an adjacent 4 seconds without CC, were collected before 1,008 defibrillation shocks from 512 out-of-hospital cardiac arrest patients. Signal quality was analyzed based on the irregularity of autocorrelation of VF. If signal quality index (SQI) was high, AMSA would be calculated from the original signal. Otherwise, CC-related artifacts would be constructed and suppressed using the least mean square filter from VF before calculation of AMSA. The algorithm was optimized using 480 training shocks and evaluated using 528 independent testing shocks.Results: Overall, CC resulted in lower SQI [0.15 (0.04-0.61) with CC vs. 0.75 (0.61-0.83) without CC, P<0.01] and higher .2) with CC vs. 7.2 (4.9-10.6) mVHz without CC, P<0.01] values.The predictive accuracy (49.2% vs. 66.5%, P<0.01) and area under the receiver operating characteristic curve (AUC) (0.647 vs. 0.734, P<0.01) were significantly decreased during CC. Using the proposed method, the estimated AMSA was 7.1 (5.0-15.2) mVHz, the predictive accuracy was 67.0% and the AUC was 0.713, which were all comparable with those calculated without CC.Conclusions: Using the signal quality-based artifact suppression method, AMSA can be reliably estimated and continuously monitored during CPR.

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

Cited by 4 publications

References 5 publications

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

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

Estimating the amplitude spectrum area of ventricular fibrillation during cardiopulmonary resuscitation using only ECG waveform

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