Abstract 277: Prediction of Return of Spontaneous Circulation: Comparison of Cerebral Oximetry and End Tidal CO 2

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Thomas W. Engel ◽  
Craig Thomas ◽  
Patrick Medado ◽  
Brian Reed ◽  
Brian J O’Neil
Keyword(s):  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Cerebral Oximetry ◽  
Convenience Sample ◽  
Return Of Spontaneous Circulation ◽  
Average Value ◽  
Shockable Rhythm ◽  
End Tidal

Background: Predicting the outcome of a cardiac arrest (CA) is exceedingly difficult. Previous literature has identified end tidal CO 2 (ETCO 2 ) as a reasonable predictor of both return of spontaneous circulation (ROSC) and futility of resuscitation. Cerebral Oximetry (CerOx) measures the regional O 2 saturation of the frontal lobes of the brain utilizing non-invasive near infrared spectroscopy and has been correlated with cerebral oxygenation. Objectives: The objective of this study is to compare measurement of ETCO 2 and CerOx to predict ROSC during both out of hospital cardiac arrests (OHCA) and emergency department cardiac arrests (EDCA). Methods: We conducted an IRB approved, prospective study on a convenience sample of patients suffering from OHCA and EDCA. Patients were monitored with ETCO 2 and CerOx simultaneously while CPR was being performed in the ED. All patients were evaluated to predict ROSC by six parameters utilizing area under the curve (AUC) values. Data was analyzed using logistic regression modeling. AUCs were compared using the Delong, Delong, and Clarke-Pearson method. Results: Overall, we analyzed 176 patients. The mean age was 62.3 ± 14.4 . 116 (66.7%)were witnessed arrest with 93 (53.8%) having received immediate CPR. The average downtime from EMS call to ED arrival was 39 minutes. The initial rhythm in these patients was 56 (31.8%) asystole, 49 (27.8%) PEA, 45 (25.6%) VF/VT, and non-shockable rhythm in 26 (14.8%) . ROSC was achieved in 46 (26.1%) of patients. The analysis of the individual variable prediction of ROSC, revealed: first value [CerOx AUC = 0.554 p = 0.1143 ; ETCO 2 AUC = 0.533, p = 0.3981], maximum value [CerOx AUC = 0.778 p < 0.0001; ETCO 2 AUC = 0.616 p = 0.0849 ], trend over the last 5 minutes [CerOx AUC = 0.821 p < 0.0001 ; ETCO 2 AUC = 0.744 p = 0.7354 ], delta from first to last value [CerOx AUC = 0.859 p < 0.0001 ; ETCO 2 AUC = 0.734 p = < 0.0001 ], average value of the penultimate minute of resuscitation [CerOx AUC = 0.814 p <0.0001 ; ETCO2 AUC = 0.759 p = 0.0003 ], and average value of the final minute of the resuscitation [CerOx AUC = 0.886 p < 0.0001 ; ETCO2 AUC = 0.770 p = 0.0001}. Conclusion: Our data shows that both ETCO2 and rSO2 are good predictors of ROSC. We found CerOx superior to ETCO 2 in predicting ROSC.

scholarly journals Excess cerebral oxygen delivery follows return of spontaneous circulation in near-term asphyxiated lambs

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shiraz Badurdeen ◽  
Andrew W. Gill ◽  
Martin Kluckow ◽  
Calum T. Roberts ◽  
Robert Galinsky ◽  
...  
Keyword(s):  
Oxygen Delivery ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Perinatal Asphyxia ◽  
Oxygen Toxicity ◽  
Spontaneous Circulation ◽  
Excess Oxygen ◽  
Cerebral Oxygen ◽  
Return Of Spontaneous Circulation ◽  
Near Term

Abstract Hypoxic-ischaemia renders the neonatal brain susceptible to early secondary injury from oxidative stress and impaired autoregulation. We aimed to describe cerebral oxygen kinetics and haemodynamics immediately following return of spontaneous circulation (ROSC) and evaluate non-invasive parameters to facilitate bedside monitoring. Near-term sheep fetuses [139 ± 2 (SD) days gestation, n = 16] were instrumented to measure carotid artery (CA) flow, pressure, right brachial arterial and jugular venous saturation (SaO2 and SvO2, respectively). Cerebral oxygenation (crSO2) was measured using near-infrared spectroscopy (NIRS). Following induction of severe asphyxia, lambs received cardiopulmonary resuscitation using 100% oxygen until ROSC, with oxygen subsequently weaned according to saturation nomograms as per current guidelines. We found that oxygen consumption did not rise following ROSC, but oxygen delivery was markedly elevated until 15 min after ROSC. CrSO2 and heart rate each correlated with oxygen delivery. SaO2 remained > 90% and was less useful for identifying trends in oxygen delivery. CrSO2 correlated inversely with cerebral fractional oxygen extraction. In conclusion, ROSC from perinatal asphyxia is characterised by excess oxygen delivery that is driven by rapid increases in cerebrovascular pressure, flow, and oxygen saturation, and may be monitored non-invasively. Further work to describe and limit injury mediated by oxygen toxicity following ROSC is warranted.

Cerebral oximetry and return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis

Resuscitation ◽  
2015 ◽  
Vol 94 ◽  
pp. 67-72 ◽  
Author(s):  
Filippo Sanfilippo ◽  
Giovanni Serena ◽  
Carlos Corredor ◽  
Umberto Benedetto ◽  
Marc O. Maybauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Cerebral Oximetry ◽  
Return Of Spontaneous Circulation

THE UTILITY OF END TIDAL CO2 (ETCO2) MONITORING DURING IN-HOSPITAL CARDIAC ARREST TO PREDICT RETURN OF SPONTANEOUS CIRCULATION

CHEST Journal ◽  
2018 ◽  
Vol 154 (4) ◽  
pp. 68A
Author(s):  
MICHAEL ROSMAN ◽  
YING (SHELLY) QI ◽  
CAITLIN O'NEILL ◽  
AMANDA MENGOTTO ◽  
JIGNESH PATEL ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
End Tidal ◽  
Hospital Cardiac Arrest ◽  
End Tidal Co2

Abstract P141: Electrocardiogram Waveform Analysis Reveals Probability of Return of Spontaneous Circulation in Both Swine and Human Subjects

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lawrence D Sherman ◽  
James T Niemann ◽  
Thomas D Rea ◽  
John P Rosborough ◽  
James D Waters ◽  
...  
Keyword(s):  
Human Subjects ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Waveform Analysis ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Percutaneous Balloon ◽  
Initial Shock ◽  
The Mean

Background: The Logarithm of the Absolute Correlations (LAC) is a measure which estimates VF duration based on the fractal dimension of the waveform. We hypothesized that the LAC measures the underlying physiology of the myocardium and would enable identification of those who would have return of spontaneous circulation (ROSC) in response to the initial shock. We tested this hypothesis in a swine model and among humans treated for out-of-hospital cardiac arrest Methods: 20 swine were placed in VF either by electrical stimulation (n=10) or through ischemia produced by percutaneous balloon occlusion of the left anterior descending artery (n=10). After 7 minutes of VF, CPR was performed for 1 min followed by defibrillation. Response to shock was recorded as ROSC if a BP of 60 mm Hg was present. The LAC was calculated for five second intervals during VF. In the human cohort, the AED ECG recordings of 165 subjects were analyzed. The average interval from 9 –1–1 call to EMS scene arrival was 5 minutes. Response to shock was recorded as ROSC if an organized rhythm corresponded with a palpable BP as determined by review of audio and written EMS report. The LAC was calculated on the 6 seconds of VF preceding the initial shock. In both the swine and human experience, we compared the mean LAC between those with and without ROSC. We calculated receiver operating characteristic (ROC) curves and measured the area under the curve to assess the diagnostic ability of the LAC. Results: In the swine model, the mean LAC differed significantly between swine with and without ROSC following the initial shock (with ROSC: 5.17±0.19 [n=6] versus without ROSC: 4.88±0.27 [n=14]: p = 0.033). The AUC for the LAC measure was 0.80. In the human cohort, the LAC also differed significantly between those with and without ROSC following the initial shock (5.21±0.34 [n=36] versus 4.81±0.47 [n=129], p < 0.0001). The AUC for the LAC measure was 0.76. Conclusions: The LAC measure predicts ROSC in both swine and human VF and can be used to guide resuscitation care. Swine ischemic VF is similar to that seen in humans.

Abstract 160: End-Tidal Carbon Dioxide > 20mmHg During Pediatric In-Hospital Cardiopulmonary Resuscitation is not Associated With Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Robert A Berg ◽  
Ronald W Reeder ◽  
Kathleen L Meert ◽  
Andrew R Yates ◽  
John T Berger ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Relative Risk ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Research Network ◽  
Sensitivity Analyses ◽  
Adjusted Relative Risk ◽  
Return Of Spontaneous Circulation ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Introduction: Based on laboratory CPR investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating end-tidal carbon dioxide (ETCO2) to &gt; 20 mmHg during CPR. Hypothesis: ETCO2 &gt; 20 mmHg during pediatric in-hospital CPR is associated with survival to hospital discharge. Methods: Children &gt; 37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for &gt; 1 minute and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. ETCO2 and Utstein-style cardiac arrest data were collected. Multivariable Poisson regression models with robust error estimates were used to estimate relative risk of outcomes. Results: Investigators blinded to outcome analyzed ETCO2 waveforms from 43 children for the first (up to) 10 minutes of CPR. During CPR, the median ETCO2 was 23 mmHg (quartiles, 16 and 28 mmHg), median ventilation rate was 29 breaths/minute (quartiles, 24 and 35 bpm), and median duration of CPR was 5 minutes [quartiles, 2 and 16 minutes]. Return of spontaneous circulation occurred after 71% of CPR events and 37% of patients survived to hospital discharge. For children with mean ETCO2 during CPR &gt; 20 mmHg, the adjusted relative risk for return of spontaneous circulation was 1.32 (0.89, 1.95), p= 0.16 and for survival to hospital discharge was 0.92 (0.41, 2.08), p= 0.84. Further sensitivity analyses were unable to demonstrate an association between mean ETCO2 &gt; 25 mmHg or &gt; 30 mmHg and ROSC or survival to hospital discharge. The median mean ETCO2 among children who survived to hospital discharge was 20 mmHg [quartiles; 15, 28 mmHg] versus 23 mmHg [16, 28 mmHg] among non-survivors. Conclusion: Mean ETCO2 &gt; 20 mmHg during pediatric in-hospital CPR was not associated with ROSC or survival to hospital discharge. ETCO2 was not demonstrably different among survivors versus non-survivors.

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