Abstract 15: Increasing Compression Rate and Depth Positively Correlate with End-Tidal Carbon Dioxide During Actual CPR Performance

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kelsey Sheak ◽  
Douglas J Wiebe ◽  
Saeed Babaeizadeh ◽  
Trevor C Yuen ◽  
Dana Zive ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Linear Regression Analysis ◽  
Ventilation Rate ◽  
Quality Data ◽  
Depth Range ◽  
Rate Range ◽  
Resuscitation Guidelines ◽  
Cpr Quality ◽  
End Tidal ◽  
Hospital Cardiac Arrest

Background: Current resuscitation guidelines suggest the use of continuous capnography to monitor the effectiveness of CPR. While laboratory data support this concept, little published clinical data exist to support this recommendation. The quantitative relationship between chest compression (CC) delivery and capnographic measurement (specifically, end-tidal CO 2 (ETCO 2 )) is poorly understood, and has important implications for CPR quality assessment. Objectives: We hypothesized that increasing rate and depth of CC will be associated in real-time with increasing ETCO 2 during both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Methods: In a multicenter cohort study, we captured time synchronized ETCO 2 and CPR quality data from resuscitation events at 4 sites between 04/2006 [[Unable to Display Character: &#8211;]] 05/2013 using CPR-sensing defibrillators (Philips Mrx-QCPR). ETCO 2 and CC rate and depth were averaged over 15-sec epochs. A linear regression analysis was performed to evaluate the relationship between CCs and ETCO 2 . Results: 29,028 epochs were processed for analysis from 583 arrest events (227 IHCA, 356 OHCA). Average age of the entire cohort was 63.7±17.1 and 213 (37%) were female. ROSC was achieved in 42% of IHCA patients and 27% of OHCA patients. CC rate range was 95-125 per min, CC depth range was 31-59 mm and ventilation rate range was 4-48 per min. CC rate was not significantly associated with ETCO 2 . CC depth was significantly associated with increased ETCO 2 . For every 10 mm increase in depth, ETCO 2 increased by 1.4 mmHg (p<.001). Ventilation rate was inversely related to higher ETCO 2 . For every 10 breaths per min increase in ventilation rate, ETCO 2 was decreased by 3.0 mmHg (p<.001) (see table). Conclusions: ETCO 2 during CPR directly correlated with CC depth, supporting the possible role of capnography as an approach to monitor the quality of CPR delivery. Confounding by ventilation rate may be an important consideration for future work.

Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest

Resuscitation ◽  
2015 ◽  
Vol 89 ◽  
pp. 149-154 ◽  
Author(s):  
Kelsey R. Sheak ◽  
Douglas J. Wiebe ◽  
Marion Leary ◽  
Saeed Babaeizadeh ◽  
Trevor C. Yuen ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Quantitative Relationship ◽  
End Tidal Carbon Dioxide ◽  
Cpr Quality ◽  
End Tidal ◽  
Hospital Cardiac Arrest

Abstract 11488: Ventilation Rate and Sustained Return of Spontaneous Circulation in In-Hospital Cardiac Arrest: Is More Better?

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ian S Jaffe ◽  
Eugene Yuriditsky ◽  
Tara Keshavarz Shirazi ◽  
Anelly Gonzales ◽  
James Horowitz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventilation Rate ◽  
Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Multicenter Prospective Observational Study ◽  
End Tidal ◽  
Essential Predicate ◽  
Hospital Cardiac Arrest

Introduction: Current consensus holds that CPR must balance chest compressions and ventilation rate (VR), with a low VR being essential for venous return and cardiac output. AHA guidelines recommend a VR of 10 ventilations per minute (vpm) after advanced airway placement. We sought to examine VR adherence and its impact on end-tidal CO 2 (ETCO 2 ) and ROSC >20 minutes. Methods: This is a retrospective analysis of data from AWARE II, a multicenter prospective observational study of adult in-hospital cardiac arrest (IHCA) outcomes at 14 US and UK sites. Inclusion criteria were: 1) adult patient in CA, 2) advanced airway already in place or placed during the CA, and 3) at least one minute of VR and ETCO 2 data available after removal of the last minute of CPR in subjects achieving ROSC (due to the rise of ETCO 2 just prior to ROSC). Results: A total of 563 subjects were enrolled in the parent study. Of these, 225 had ETCO 2 and VR tracings available, and 201 had sufficient data for inclusion. Mean age was 69.3 (range 18-100), patients were 63.7% male, and 16.4% had a shockable initial rhythm. A total of 116 subjects (57.7%) achieved ROSC, which was sustained in 76 (37.8%), leading to survival to hospital discharge with favorable neurological outcomes in 9 (4.5%). Mean VR was 16.3 vpm, with 171 (85.1%) subjects being ventilated in excess of guidelines; only 16 (8.0%) subjects received 8-10 vpm. Higher VR had a weak but significant association with increased mean ETCO 2 (linear R 2 = 0.11, p < 1x10 -6 ) and sustained ROSC (OR 1.05; 95% CI: 1.01-1.11; p = 0.02). Patients with sustained ROSC had a significantly higher VR at 17.7 vpm than those without sustained ROSC at 15.6 vpm (p = 0.007). Patients receiving a VR close to AHA guidelines (6-12 vpm) had a significantly lower rate of sustained ROSC (26.1%, n = 46) than patients receiving >12 vpm (42.0%, n = 148) (OR 2.30; 95% CI: 1.08-4.89; p = 0.031 using a multivariate model including patient age, shockable initial rhythm, known cardiac disease, witnessed IHCA, and use of mechanical compressions). Conclusions: VR within AHA guidelines is rare during IHCA. However, ventilation in excess of current guidelines may increase rates of sustained ROSC, an essential predicate to survival. AHA guidelines on VR in CPR with an advanced airway may not yet be optimized.

Abstract 11901: CPR Quality During the COVID-19 Pandemic - More Evidence of Collateral Damage During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jocasta Ball ◽  
Ziad Nehme ◽  
Melanie Villani ◽  
Karen L Smith
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Healthcare Services ◽  
Quality Data ◽  
Independent Effect ◽  
Compression Rate ◽  
Post Shock ◽  
Cpr Quality ◽  
Using Data ◽  
Hospital Cardiac Arrest

Introduction: Many regions around the world have reported declining survival rates from out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic. This has been attributed to COVID-19 infection and overwhelmed healthcare services in some regions and imposed social restrictions in others. However, the effect of the pandemic period on CPR quality, which has the potential to impact outcomes, has not yet been described. Methods: A retrospective observational study was performed using data collected in an established OHCA registry in Victoria, Australia. During a pre-pandemic period (11 February 2019-31 January 2020) and the COVID-19 pandemic period (1 February 2020-31 January 2021), 1,111 and 1,349 cases with attempted resuscitation had complete CPR quality data, respectively. The proportion of cases where CPR targets (chest compression fraction [CCF]≥90%, compression depth 5-10cm, compression rate 100-120 per minute, pre-shock pauses <6 seconds, post-shock pauses <5 seconds) were met was compared between the pre-pandemic and pandemic periods. Logistic regression was performed to identify the independent effect of the COVID-19 pandemic on achieving CPR targets. Results: The proportion of arrests where CCF≥90% significantly decreased during the pandemic (57% vs 74% in the pre-pandemic period, p<0.001) as did the proportion with pre-shock pauses <6 seconds (54% vs 62%, p=0.019) and post-shock pauses <5 seconds (68% vs 82%, p<0.001). However, the proportion within target compression rate significantly increased during the pandemic (64% vs 56%, p<0.001). Following multivariable adjustment, the COVID-19 pandemic period was independently associated with a decrease in the odds of achieving a CCF≥90% (adjusted odds ratio [AOR] 0.47 [95% CI 0.40, 0.56]), a decrease in the odds of achieving pre-shock pauses<6 seconds (AOR 0.71 [95% CI 0.52, 0.96]), and a decrease in the odds of achieving post-shock pauses<5 seconds (AOR 0.49 [95% CI 0.34, 0.71]). Conclusion: CPR quality was impacted during the COVID-19 pandemic period which may have contributed to a decrease in OHCA survival previously identified. These findings reinforce the importance of maintaining effective resuscitation practices despite changes to clinical context.

Abstract 239: The Effect of an Interdisciplinary Simulation Training Program on Translational Outcomes for In-Hospital Cardiopulmonary Arrests

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
John Hunninghake ◽  
Justin Reis ◽  
Heather Delaney ◽  
Matthew Borgman ◽  
Raquel Trevino ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Hospital Discharge ◽  
Team Training ◽  
Quality Data ◽  
P Value ◽  
Significant Difference ◽  
Event Location ◽  
Cpr Quality ◽  
Hospital Cardiac Arrest

Purpose: High-quality cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) is the primary component influencing return of circulation (ROSC) and survival to hospital discharge, but few hospitals regularly track these metrics. Other studies have demonstrated significant improvements in survival after IHCA events following implementation of a dedicated code team training program. Therefore, we developed a unique curriculum for a Code Team Training (CTT) course, and evaluated its post-implementation effect on CPR quality and post-IHCA patient outcomes at our institution. Methods: CPR quality data was prospectively collected for quality improvement purposes once our institution had that capability, with 12-months pre-CTT and 21 months post-CTT. Pre-CTT data shaped the elements of the four-hour CTT course that included didactics, small group sessions, and high-fidelity simulation exercises. A total of 456 multi-professional code team members were trained in 22 courses. Data collection included CPR quality and translational outcomes for events where CPR was performed, except the ED. CodeNet® software was used for CPR quality measures, cardiac rhythm, defibrillation metrics, use of continuous waveform capnography, and pauses in compressions. Target metrics for CPR quality were based on 2015 AHA guidelines. Key translational outcomes measures included event location, ROSC, and survival to hospital discharge. Results: CPR quality was obtained from 140 of 230 (61%) in- and out-of-hospital pulseless adult cardiac arrest events over 33 months (50 [36%] before CTT and 90 [64%] following the first course). There was no significant difference between groups in terms of event location within the hospital nor initial event rhythm. A total of 116,908 chest compressions were evaluated. Median compressions in target rate improved from 32% before CTT to 49% after CTT (p<0.05). When accounting for target rate and depth, the median compressions rate improved to 38% post-CTT compared to 31% pre-CTT (p<0.05). While compression depth had a non-statistically significant decline (90.8% pre-CTT and 83.4% post-CTT), mean rate and median rate-in-target improved from 119.99 +/- 15.6 cpm and 32.4% pre-CTT to 113.7 +/- 16.1 cpm and 48.6% post-CTT (p<0.05). The rate of ROSC improved from 60% (30 of 50) to 78% (70 of 90) after implementation of CTT (p=0.003), excluding IHCA in the ED. Index IHCA survival rate for our institution improved from 26% to 33% before and after CTT [p-value NS], which far surpasses the national average (23.8%). Conclusions: After the initiation of a CTT course that targets key code team member personnel, CPR quality significantly improved, which was associated with an increase in ROSC and a trend towards increased survival for in-hospital cardiac arrest patients.

AS13 The association between end-tidal CO2 and CPR quality metrics in out-of-hospital cardiac arrest

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S4
Author(s):  
Daniel Spaite ◽  
Uwe Stolz ◽  
Annemarie Silver ◽  
Christopher Kaufman ◽  
Keith Pyers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Metrics ◽  
Cpr Quality ◽  
End Tidal ◽  
Hospital Cardiac Arrest ◽  
End Tidal Co2

Correlations Between CPR Quality Metrics and End-Tidal CO2 in Out-of-Hospital Cardiac Arrest

Resuscitation ◽  
2012 ◽  
Vol 83 ◽  
pp. e9
Author(s):  
Daniel W. Spaite ◽  
Uwe Stolz ◽  
Ryan Ann Murphy ◽  
Madalyn Karamooz ◽  
Annemarie Silver ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Metrics ◽  
Cpr Quality ◽  
End Tidal ◽  
Hospital Cardiac Arrest ◽  
End Tidal Co2

Association between Prehospital CPR Quality and End-Tidal Carbon Dioxide Levels in Out-of-Hospital Cardiac Arrest

2016 ◽  
Vol 20 (3) ◽  
pp. 369-377 ◽  
Author(s):  
Ryan A. Murphy ◽  
Bentley J. Bobrow ◽  
Daniel W. Spaite ◽  
Chengcheng Hu ◽  
Robyn McDannold ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
End Tidal Carbon Dioxide ◽  
Cpr Quality ◽  
Carbon Dioxide Levels ◽  
End Tidal ◽  
Hospital Cardiac Arrest

scholarly journals LO01: Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S6-S6
Author(s):  
S. M. Fernando ◽  
C. Vaillancourt ◽  
S. Morrow ◽  
I. G. Stiell
Keyword(s):  
Cardiac Arrest ◽  
Compression Rate ◽  
High Quality ◽  
Shock Delivery ◽  
Automated External Defibrillators ◽  
Resuscitation Guidelines ◽  
Bystander Cpr ◽  
Cpr Quality ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, and CPR quality is one of the few modifiable factors associated with improved outcomes. Particularly, bystander CPR has been shown to improve survival and neurological outcomes in OHCA. However, the quality of CPR performed by bystanders in OHCA is unknown. We evaluated bystander CPR quality during OHCA, utilizing data stored within Automated External Defibrillators (AEDs), and matched with cases enrolled in the Resuscitation Outcomes Consortium (ROC) database. Methods: This cohort study included adult OHCA cases from the Ottawa ROC site between 2011-2016, which were of presumed cardiac etiology, not witnessed by EMS, and where an AED was utilized by a bystander with > 1 minute of CPR process data available. AED data from Ottawa Paramedic Services was matched to each case identified by the ROC database. AED data was analyzed using manufacturer software to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and bystander adherence to existing 2010 Resuscitation Guidelines. Results: 100 cases met all inclusion criteria. 75.0% of patients were male, with a mean age of 62.3 years. 58.0% of arrests occurred in the home setting, and 24.0% were witnessed arrests. Initial rhythm was ventricular fibrillation/ventricular tachycardia in 36.0% of cases. Overall survival rate was 42.0%, with a modified Rankin Score of 3.7 (95% CI: 2.9-4.5). Bystanders demonstrated high-quality CPR over the course of resuscitation, with a chest compression fraction (CCF) of 75.9% (73.6-78.1), a compression depth of 5.26 cm (5.03-5.49), and a compression rate of 111.2/min (107.7-114.7). Mean peri-shock pause was 26.8 seconds (24.6-29.1). Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were 66.0% (60.9-71.1) and 54.9% (48.6-61.3), respectively. CPR quality was lowest in the first minute of resuscitation, during which rhythm analysis took place (mean 40.5 sec). In cases involving a shockable rhythm, overall latency from initiation of AED to shock delivery was 59.2 sec (45.5-72.8). Conclusion: We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. Our findings provide evidence of the quality of bystander CPR performed during OHCA.

Sign in / Sign up

Export Citation Format

Share Document