Abstract 19572: Elevated PETCO2 During Cardiac Resuscitation Without Return of Spontaneous Circulation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cameron Hypes ◽  
Dan Spaite ◽  
Tyler Vadeboncoeur ◽  
Ryan A Murphy ◽  
Chengcheng Hu ◽  
...  
Keyword(s):  
Cardiac Rhythm ◽  
Vital Signs ◽  
Mean Value ◽  
Spontaneous Circulation ◽  
Accelerometer Data ◽  
Improvement Program ◽  
Study Population ◽  
Cpr Quality ◽  
The Mean ◽  
End Tidal

Background: Quantitative End-Tidal CO2 (PETCO2) measurement during cardiac arrest is recommended for monitoring the CPR quality to detect ROSC. While low ETC02 can reflect suboptimal CPR quality and increases in ETC02 are often associated with ROSC the significance of high values of PETCO2 without ROSC remain unclear. Objectives: To describe the population of OHCA victims with high PETCO2 (>50 mm Hg) during ongoing resuscitation including demographics, rhythm characteristics, occurrence of ROSC, the later occurrence of field termination of resuscitation and the presumed etiology. Methods: An observational analysis of adult OHCAs with available PETCO2 data occurring between Oct 2010 and Nov 2014 at two sites involved in the Save Hearts in Arizona Registry and Education (SHARE) quality improvement program. CPR and PETCO2 data were recorded using ZOLL E and X Series EMS monitors. PETCO2 is reported as the mean value for each minute. The cardiac rhythm and the presence of ROSC were determined for each minute using EMS provider reports, vital signs, ECG, and accelerometer data. The first recorded minute of PETCO2 and minutes with ROSC were excluded. Results: Study population included 654 OHCAs with PETCO2 data, 96 cases (58% male, age median 65 (IQR 54-75)) with at least 1 min of high PETCO2 in the absence of ROSC were identified. Of these, 31 (32%) had ROSC at least once during their resuscitation. Cases were of presumed cardiac etiology in 81 (84%), while 12% and 4% had presumed respiratory and other etiologies, respectively. A total of 322 minutes of PETCO2 >50 mm Hg in the absence of ROSC were identified. The mean PETC02 value was 67 (IQR 54-75). Of these 296 minutes (92%) occurred during PEA. Despite high PETCO2, resuscitation was terminated in the field in 21 (22%) patients. Only one subject survived to hospital discharge. Conclusions: In this observational study, high PETCO2 was frequently found during resuscitation without ROSC and PEA was the most common cardiac rhythm. Further study is warranted to determine the significance and possible reasons for this finding.

scholarly journals The Effect of Age, Gender, Refractive Status and Axial Length on the Measurements of Hertel Exophthalmometry

2015 ◽  
Vol 9 (1) ◽  
pp. 113-115 ◽  
Author(s):  
Omer Karti ◽  
Ozlem B Selver ◽  
Eyyup Karahan ◽  
Mehmet O Zengin ◽  
Murat Uyar
Keyword(s):  
Axial Length ◽  
Adult Population ◽  
Mean Value ◽  
Normative Values ◽  
Length Standard ◽  
Refractive Status ◽  
Study Population ◽  
The Mean ◽  
Effect Of Age ◽  
Healthy Females

Purpose : To evaluate the normal distribution of exophthalmometric values in Turkish adult population and the effect of age, gender, refractive status and axial length on globe position. Methods : One hundred and twenty-two males and 114 healthy females with age ranging from 18 to 87 years were included in the study. The study population was recruited from patients presenting to our institution for routine refractive examination. Hertel exophthalmometer was used to measure the degree of ocular protrusion. Effect of age, refractive error, interpupillary distance, and axial length on globe position was detected with linear regression analyses. Results : The mean Hertel exophthalmometric size was 15.7+2.6 mm (range; 11 to 21 mm). The mean value for males was 16.1±2.6 mm (range; 11 to 21 mm), and for females 15.5±2.6 mm (range; 11 to 20 mm). The mean distance between the lateral rims of the orbit was 102 + 5.1 mm (range; 88 to 111mm). The mean exophthalmometric values were not statistically different in males and females. Age and mean spherical equivalents were negatively correlated with exophthalmometric measurements. Axial length was positively correlated with exophthalmometric measurements. Conclusion : The exophthalmometric measurement of the eye is affected by the age, spherical equivalent and the axial length. Standard normative values of the Hertel exophthalmometric measurements should be reevaluated with larger samples.

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

scholarly journals Assessment of Alteration in Capnometry Monitoring during Intravenous Sedation with Midazolam for Oral Surgical Procedures

2017 ◽  
Vol 18 (11) ◽  
pp. 1025-1028
Author(s):  
Madhavi Singh ◽  
Kavitha G ◽  
Pallavi K Kakade ◽  
Mahesh Ahire ◽  
Melvin Augustine ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
Surgical Procedures ◽  
Mean Value ◽  
Intravenous Sedation ◽  
Oral Surgical Procedures ◽  
The Social ◽  
The Mean ◽  
Spss Software ◽  
Oral Surgical Procedure ◽  
End Tidal

ABSTRACT Introduction Capnography is routinely used for monitoring of patients subjected to sedation for different surgical procedures. There is still paucity of data highlighting the capnographic assessment of patients on midazolam sedation undergoing oral surgical procedures. Hence, we planned the present study to assess the alterations occurring in the end-tidal carbon dioxide (ETCO2) values monitored during intravenous (IV) sedation with midazolam during various oral surgical procedures. Materials and methods The present study included assessment of alteration in ETCO2 values occurring during oral surgical procedure. After meeting the inclusion and exclusion criteria, a total of 40 participants were included in the present study. Pulse oximeter with capnograph (EmcoMeditek Pvt., Ltd., India) device was used for assessment of respiratory rate (RR) and ETCO2 values. The mean of 12 readings over a period of 1 minute before the starting of first infusion was referred to as baseline time. By evaluating the first four readings at an interval of 15 seconds during the 1st minute of infusion, we obtained the 1 minute average reading. All the data were compiled and recorded and assessed by the Statistical Package for the Social Sciences (SPSS) software. Results A total of 40 participants were included, out of which, 20 were males and 20 were females. At the baseline time, mean value of ETCO2 was 31 mm Hg, while mean value of oxygen saturation (SpO2) was 36%. Out of total 40 participants, 15 showed the presence of respiratory depression. Out of these 15 participants, ETCO2 changes from baseline were observed in 13 participants. Conclusion No oxygen should be delivered, unless until required, to the healthy participants undergoing dental sedation procedures, for marinating the sensitivity of pulse oximetry during assessment of respiratory depression. Clinical significance In patients undergoing sedation procedures, various monitoring techniques should be employed as respiratory depression is a commonly encountered risk factor. How to cite this article G Kavitha, Kakade PK, Singh M, Ahire M, Augustine M, Jain KD. Assessment of Alteration in Capnometry Monitoring during Intravenous Sedation with Midazolam for Oral Surgical Procedures. J Contemp Dent Pract 2017;18(11):1025-1028.

Objective cyclodeviation measurement in normal subjects by means of Cyclocheck® application

2020 ◽  
pp. 112067212090531
Author(s):  
Justyna Simiera ◽  
Agata Joanna Ordon ◽  
Piotr Loba
Keyword(s):  
Normal Subjects ◽  
Mean Value ◽  
Angle Measurements ◽  
Corrected Visual Acuity ◽  
Normal Individuals ◽  
Muscle Balance ◽  
Study Population ◽  
The Mean ◽  
Fundus Photographs ◽  
The Right

Purpose: To evaluate the range of cyclodeviation in normal individuals by means of Cyclocheck® application recently designed by the authors and freely available at www.cyclocheck.com . Methods: Healthy subjects with normal muscle balance, best-corrected visual acuity of ⩾0.8, and stereopsis on Randot charts of ⩽100 s of arc were included in the study. Two separate digital fundus photographs were taken of each eye of every patient. The disk-foveal angle was calculated using the Cyclocheck® application. The average result of the disk-foveal angle measurements were considered for data analysis. Results: A total of 131 patients met inclusion criteria for the study population. The mean value of the disk-foveal angle in the whole study group (both right and left eye) was 6.39° ± 2.72° with 5.26° ± 2.56° (range from −0.4° to 12.55°) in the right eye and 7.52° ± 2.39° (range from 1.25° to 12.76°) in the left eye. The mean value of the disk-foveal angle of the left eye was greater by 2.26° than that of the right eye. Conclusion: Cyclocheck® software allows easy assessment of cyclodeviation. Normal individuals present with a positive value of the disk-foveal angle with a certain spread of the results. The analysis of obtained measurements revealed a significant asymmetry between both eyes with the left eye being more excyclodeviated in an otherwise orthotropic population, which remains a subject for further investigations.

Abstract 17380: End-tidal Carbon Dioxide During Resuscitation is Associated With CPR Depth and Ventilatory Rate

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joseph Tonna ◽  
Cabe R Clark ◽  
Benjamin R Fogg ◽  
Scott Youngquist
Keyword(s):  
Carbon Dioxide ◽  
Univariate Analysis ◽  
Laryngeal Tube ◽  
Spontaneous Circulation ◽  
End Tidal Carbon Dioxide ◽  
Initial Rhythm ◽  
Cpr Quality ◽  
Quadratic Response ◽  
End Tidal ◽  
Average Rise

Introduction: End-tidal carbon dioxide (ETCO2) has been proposed as a physiologic marker of blood flow during CPR. Hypothesis: We hypothesized that ETCO2 values would be associated with initial rhythm, witnessed status, impedance threshold device (ITD) use, CPR quality measures and ventilatory rates (VR). Methods: Chest compression (CC) metrics, VR, and ETCO2 values from prehospital resuscitation attempts were averaged over each 1 min of resuscitation. When return of spontaneous circulation (ROSC) was identified, as evidenced by the cessation of CC and measurement of a blood pressure, we censored 1 min prior to the termination of CC to reduce the measurement of unrecognized ROSC physiology. Mixed effects models were used for analysis. Results: Monitor data from N=102 adult prehospital resuscitation attempts was available for analysis, providing 1,079 (1-min) epochs for analysis (median of 8 min/case, IQR 4-14). ETCO2 appeared at a median of 9 min (IQR 6-12) into resuscitation, measured from an endotracheal tube (78%), laryngeal tube (21%), and bag valve mask (1%). Median VR was 9 breaths/min (IQR 6-11). Average initial ETCO2 was 28 (95% CI 25-31) followed by an average rise of 0.8 mm Hg/min (95% CI 0.5-1.1), regardless of ITD use, initial rhythm, or witnessed status. In univariate analysis, ETCO2 was not associated with CC fraction, rate, or release velocity but was associated with CC depth (2.7 mm Hg/inch of depth, 95% CI 0.1-5.4), and VR (quadratic response, p<0.0001). Results held in multivariate analysis. In the narrow range of low VRs observed in our sample, increased VRs were associated with higher ETCO2 values between 0-17 breaths/min before falling at higher rates (FIGURE). Conclusions: Similar to others, we observed a linear association between ETCO2 and CC depth but a quadratic relationship between ETCO2 and VR during prehospital resuscitation. Improving CC depth and maintaining a VR of 10 breaths/min may optimize ETCO2 values in adults.

An observation of umbilical coiling index in a low risk population in Nigeria

2018 ◽  
Vol 46 (3) ◽  
pp. 341-345 ◽  
Author(s):  
Kikelomo T. Adesina ◽  
Olumuyiwa A. Ogunlaja ◽  
Adebunmi O. Olarinoye ◽  
Abiodun P. Aboyeji ◽  
Halimat J. Akande ◽  
...  
Keyword(s):  
Congenital Abnormalities ◽  
Mean Value ◽  
Adverse Perinatal Outcome ◽  
Umbilical Coiling Index ◽  
Study Population ◽  
Foetal Outcome ◽  
The Mean ◽  
Umbilical Cords ◽  
Cord Length ◽  
Gross Examination

Abstract Objectives: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. Methods: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. Results: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. Conclusion: The UCI was not associated with adverse perinatal outcome in this study.

scholarly journals PROGRESSION OF AUTOANTIBODIES ANTI-GAD AND ANTI-IA2 IN TYPE 1A DIABETICS AGED OF 5 TO 21 YEARS IN CÔTE D’IVOIRE

2019 ◽  
Author(s):  
Aïssé Florence Judith Trébissou ◽  
Chiayé Claire Antoinette Yapo-Crezoit ◽  
Pascal Sibailly ◽  
Mamadou Sanogo ◽  
Amos Ankotché ◽  
...  
Keyword(s):  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Cell Mass ◽  
Mean Value ◽  
Cote D’Ivoire ◽  
Gad Autoantibodies ◽  
A Value ◽  
Côte D'ivoire ◽  
Study Population ◽  
The Mean

AbstractBackgroundDiabetes autoantibodies are indispensable markers of diabetes classification.Objectiveto research autoantibodies anti-GAD and anti-IA2 in type 1A diabetics (T1D) aged 5 to 21 years, and to follow the progression of these autoantibodies in T1D patients, in Côte d’Ivoire.MethodsThe study population composed of 28 T1D patients, aged 5 to 21 years. T1D were followed up in two diabetes care centers in Abidjan district, Endocrinology departments of U.H.C of Yopougon and Treichville. Anti-GAD and anti-IA2 autoantibodies were researched by ELISA.Resultsanti-GAD and anti-IA2 were present in T1D and their siblings. After 2 years of diabetes, the titer of the anti-GAD autoantibodies increased to the mean value of 677.10 ± 353.20 IU / ml. Then, a fall of the anti-GAD autoantibodies until the cancellation was observed from the 8th to the 9th with values of 117 IU / ml to 10.14 IU / ml. Anti-IA2 autoantibodies fall at 9th year of diabetes with a value of 55.10 IU / ml.Conclusionanti-GAD and anti-IA2 autoantibodies persist after 9 years of diabetes, causing total destruction over time of the pancreatic β-cell mass in patients from Côte d’Ivoire, leading them to the death.

Abstract 333: End-Tidal Carbon Dioxide, CPR Quality and ROSC During Pediatric Cardiac Arrests in a Large Academic Children’s Hospital, 2013-2018

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jill L Sorcher ◽  
Elizabeth A Hunt ◽  
Donald H Shaffner ◽  
Justin Jeffers ◽  
Heather Newton ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Chest Compression ◽  
Chest Compressions ◽  
Significant Difference ◽  
End Tidal Carbon Dioxide ◽  
Study Population ◽  
Cpr Quality ◽  
Data Files ◽  
Pediatric Populations ◽  
End Tidal

Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Calibri",sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Little evidence exists to guide end-tidal carbon dioxide (ETCO 2 ) use during cardiac arrest events in pediatric populations. Despite this, integrating physiologic feedback, including ETCO 2 , into resuscitation optimization is recognized as an important component to precision resuscitation. This was a prospective observational study of ETCO 2 , CPR quality and ROSC. The study population included any pediatric patient who received chest compressions from January 1, 2013 through July 10, 2018 in the Johns Hopkins Children’s Center. During this time, 457 arrest events of any length requiring chest compressions occurred. Of these events, 274 utilized ETCO 2 in some capacity and 198 recorded ETCO 2 on a Zoll R Series® defibrillator. Data files from 145 of these events that contained both chest compression and ETCO 2 data were successfully obtained. These 145 events contained 2200 minutes of ETCO 2 data and 2156 minutes of both chest compression and ETCO 2 data; values are reported as median [IQR]. The average ETCO 2 for all events was 21 mmHg [15-32]. ETCO 2 by age category was (0-1: 12 [0-29]; 1-8: 20 [2-35]; 8+: 10.15 [0-21]). When comparing patients who achieved ROSC > 20 minutes to those who did not, we observed a significant difference in ETCO 2 between those who survived and those who did not (ROSC: 25 [15-30] vs. NO ROSC: 15 [9-22]; p<0.001). Analysis to assess associations between ROSC and chest compression depth, rate, and fraction are underway. In this analysis of the largest set of pediatric ETCO 2 and resuscitation data, our findings suggest that a difference may exist in survival associated with an ETCO 2 difference between 15 and 20 mmHg.

scholarly journals Bispectral Index Monitoring (BIS) as a Guide for Intubation Without Neuromuscular Blockade in Office-Based Pediatric General Anesthesia: A Retrospective Evaluation

2011 ◽  
Vol 58 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Zakaria S Messieha ◽  
Samuel Guirguis ◽  
Sherine Hanna
Keyword(s):  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Bispectral Index ◽  
Index System ◽  
Muscle Relaxation ◽  
Pediatric Anesthesia ◽  
Vital Signs ◽  
Mean Value ◽  
American Society ◽  
End Tidal

The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.

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