Abstract 264: Automatic Detection of Ventilations Using the Thoracic Impedance Signal During Lucas Chest Compressions

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Xabier Jaureguibeitia ◽  
Unai Irusta ◽  
Elisabete Aramendi ◽  
Pamela Owens ◽  
Henry E Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Minute Ventilation ◽  
Lung Ventilation ◽  
Detection Algorithm ◽  
Ventilation Rate ◽  
Thoracic Impedance ◽  
Chest Compressions ◽  
Signal Processing Algorithm ◽  
Ventilation Rates ◽  
Mechanical Cpr

Introduction: Resuscitation from out-of-cardiac arrest (OHCA) requires control of both chest compressions and lung ventilation. There are few effective methods for detecting ventilations during cardiopulmonary resuscitation. Thoracic impedance (TI) is sensitive to changes in lung air volumes and may allow detection of ventilations but has not been tested with concurrent mechanical chest compressions. Hypothesis: It is possible to automatically detect and characterize ventilations from TI changes during mechanical chest compressions. Methods: A cohort of 420 OHCA cases (27 survivors to hospital discharge) were enrolled in the Dallas-Fort Worth Center for Resuscitation Research cardiac arrest registry. These patients were treated with the LUCAS-2 CPR device and had concurrent TI and capnogram recordings from MRx (Philips, Andover, MA) monitor-defibrillators. We developed a signal processing algorithm to suppress chest compression artifacts from the TI signal, allowing identification of ventilations. We used the capnogram as gold standard for delivered ventilations. We determined the accuracy of the algorithm for detecting capnogram-indicated ventilations, calculating sensitivity, the proportion of true ventilations detected in the TI, and positive predictive value (PPV), the proportion of true ventilations within the detections. We calculated per minute ventilation rate and mean TI amplitude, as surrogate for tidal volume. Statistical differences between survivors and non-survivors were assessed using the Mann-Whitney test. Results: We studied 4331 minutes of TI during CPR. There were a median of 10 (IQR 6-14) ventilations per min and 52 (30-81) ventilations per patient. Sensitivity of TI was 95.9% (95% CI, 74.5-100), and PPV was 95.8% (95% CI, 80.0-100). The median ventilation rates for survivors and non-survivors were 7.75 (5.37-9.91) min -1 and 5.64 (4.46-7.15) min -1 (p<10 -3 ), and the median TI amplitudes were 1.33 (1.03-1.75) Ω and 1.14 (0.77-1.66) Ω (p=0.095). Conclusions: An accurate automatic TI ventilation detection algorithm was demonstrated during mechanical CPR. The relation between ventilation rate during mechanical CPR and survival was significant, but it was not for impedance amplitude.

Abstract P101: Comparison of Ventilation Rate Measured with Thoracic Bioimpedance and with Capnography during Out-of-Hospital Cardiopulmonary Resuscitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ahamed H Idris ◽  
Sarah Beadle ◽  
Mohamud Daya ◽  
Dana Zive
Keyword(s):  
Cardiac Arrest ◽  
Ventilation Rate ◽  
Rater Agreement ◽  
Chest Compressions ◽  
Intra Class Correlation ◽  
Automated Software ◽  
Ventilation Rates ◽  
Patient File ◽  
Hospital Cardiac Arrest ◽  
Manual Review

Objective: To determine the ability of thoracic bioimpedance to measure ventilation rate during cardiac arrest and CPR. Methods: Philips MRx devices monitored 32 patients during out-of-hospital cardiac arrest and CPR. The devices recorded chest compressions with an accelerometer, continuous 1-lead EKG, thoracic bioimpedance, and continuous capnography. Of the 32 files, 4 were not used in this study because of incomplete recording. Two reviewers manually annotated ventilation waveforms independently using Laerdal QCPR software, which also automatically annotated ventilation through the bioimpedance channel. Reviewers manually measured ventilation rate (number of breaths/min) recorded with capnography for each 1 minute epoch, which were matched and compared with those measured through bioimpedance for each patient file (N = 28). A total of 585 1-minute epochs were measured and compared. We assessed intra-class correlation for 2 individual raters for ventilation rates measured with capnography and with annotated bioimpedance to establish inter-user reliability of measurements. Ventilation rate measured with capnography vs. bioimpedance was compared with simple regression. Results: The majority (60%) of ventilation rates measured with capnography and with automated software bioimpedance were within 2 breaths/min of each other. After manual annotation of the bioimpedance channel, 81% of 1-min epochs were within 2 breaths/min of rates measured with capnography. Ventilation rate measured with capnography had good correlation with bioimpedance (r = .82, p < .0001). Inter-rater agreement is estimated to be 0.96 for ventilation rate measured with capnography and 0.93 for rate measured with bioimpedance. Discussion: The software occasionally missed obvious ventilation waveforms and occasionally annotated waveforms obviously caused by chest compressions. Manual review and annotation improved the accuracy of ventilation rates measured with bioimpedance. Approximately 75% to 90% of recordings made with the Philips MRx device are expected to be useful for measurement. Conclusion: Ventilation rate measured with thoracic bioimpedance alone is acceptable using the Philips MRx device. Inter-rater agreement for measurements is excellent.

A Cross-Over Trial Comparing Conventional to Compression-Adjusted Ventilations with Metronome-Guided Compressions

2019 ◽  
Vol 34 (02) ◽  
pp. 220-223 ◽  
Author(s):  
Dhimitri A. Nikolla ◽  
Brandon J. Kramer ◽  
Jestin N. Carlson
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Null Hypothesis ◽  
Basic Life Support ◽  
Life Support ◽  
Minute Ventilation ◽  
Group Versus ◽  
Time Intervals ◽  
Minute Interval ◽  
Ventilation Rates

Introduction:Hyperventilation during cardiopulmonary resuscitation (CPR) negatively affects cardiopulmonary physiology. Compression-adjusted ventilations (CAVs) may allow providers to deliver ventilation rates more consistently than conventional ventilations (CVs). This study sought to compare ventilation rates between these two methods during simulated cardiac arrest.Null Hypothesis:That CAV will not result in different rates than CV in simulated CPR with metronome-guided compressions.Methods:Volunteer Basic Life Support (BLS)-trained providers delivered bag-valve-mask (BVM) ventilations during simulated CPR with metronome-guided compressions at 100 beats/minute. For the first 4-minute interval, volunteers delivered CV. Volunteers were then instructed on how to perform CAV by delivering one breath, counting 12 compressions, and then delivering a subsequent breath. They then performed CAV for the second 4-minute interval. Ventilation rates were manually recorded. Minute-by-minute ventilation rates were compared between the techniques.Results:A total of 23 volunteers were enrolled with a median age of 36 years old and with a median of 14 years of experience. Median ventilation rates were consistently higher in the CV group versus the CAV group across all 1-minute segments: 13 vs 9, 12 vs 8, 12 vs 8, and 12 vs 8 for minutes one through four, respectively (P &lt;.01, all). Hyperventilation (&gt;10 breaths per minute) occurred 64% of the time intervals with CV versus one percent with CAV (P &lt;.01). The proportion of time which hyperventilation occurred was also consistently higher in the CV group versus the CAV group across all 1-minute segments: 78% vs 4%, 61% vs 0%, 57% vs 0%, and 61% vs 0% for minutes one through four, respectively (P &lt;.01, all).Conclusions:In this simulated model of cardiac arrest, CAV had more accurate ventilation rates and fewer episodes of hyperventilation compared with CV.Nikolla DA, Kramer BJ, Carlson JN. A cross-over trial comparing conventional to compression-adjusted ventilations with metronome-guided compressions. Prehosp Disaster Med. 2019;34(2):220–223

Animal Experiments on the Effects of PEEP and Different Ventilation-Compression Ratios in Neonatal Cardiopulmonary Resuscitation

1985 ◽  
Vol 1 (S1) ◽  
pp. 214-215
Author(s):  
W. F. Dick ◽  
E. Traub ◽  
K. Engels ◽  
K. -H. Lindner
Keyword(s):  
Body Weight ◽  
Cardiac Arrest ◽  
Artificial Ventilation ◽  
Animal Experiments ◽  
Ventilation Rate ◽  
Positive End Expiratory Pressure ◽  
Cardiac Compression ◽  
Ventilation Rates ◽  
Average Body ◽  
Average Body Weight

The physiological range of respiratory rates and heart rates in neonates is approximately 40 per min and 120 per min, respectively, which yields a theoretical ventilation-compression ratio of 1:3ratherthan 1:5.Thirty-six anesthetized pigs with an average body weight of 4–5 kg were used in the study. After establishing a steady state by artificial ventilation with 100% oxygen, a cardiac arrest was induced by an intravenous injection of potassium chloride. Following the cardiac arrest, the animals were resuscitated with ventilation rates of 30 and 40 per min, respectively, while external cardiac compression was performed at rates between 60 and 160 per min. Randomly selected animals were resuscitated with ventilation-compression ratios of 1:2, 1:3 and 1:4 for 10 min each, 6 animals each were ventilated using a ventilation rate of 30 per min, 40 per min, or positive end-expiratory pressure.

Military application of mechanical CPR devices: a pressing requirement?

2018 ◽  
Vol 164 (6) ◽  
pp. 438-441
Author(s):  
Iain T Parsons ◽  
A T Cox ◽  
P S C Rees
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Potential Utility ◽  
Operational Environment ◽  
Chest Compressions ◽  
High Quality ◽  
Military Application ◽  
The Military ◽  
Mechanical Cpr

Maintaining high-quality chest compressions during cardiopulmonary resuscitation following cardiac arrest presents a challenge. The currently available mechanical CPR (mCPR) devices are described in this review, coupled with an analysis of the evidence pertaining to their efficacy. Overall, mCPR appears to be at least equivalent to high-quality manual CPR in large trials. There is potential utility for mCPR devices in the military context to ensure uninterrupted quality CPR following a medical cardiac arrest. Particular utility may be in a prohibitive operational environment, where manpower is limited or where timelines to definitive care are stretched resulting in a requirement for prolonged resuscitation. mCPR can also act as a bridge to advanced endovascular resuscitation techniques should they become more mainstream therapy.

Abstract 100: Mechanical Devices Are More Effective than Manual Compressions Regarding Resuscitation Concomitant with Emergency Percutaneous Coronary Intervention in Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luis A Dallan ◽  
Tulio T Vargas ◽  
Bruno L Janella ◽  
Jamil R Cade ◽  
Breno O Almeida ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Coronary Angioplasty ◽  
Coronary Intervention ◽  
Percutaneous Coronary Interventions ◽  
Chest Compressions ◽  
Percutaneous Coronary ◽  
Mechanical Cpr

Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronary intervention concomitant with CPR. Intra-coronary curves were measured initially during manual chest compressions (manual CPR) and later, after the correct installation of AutoPulse® during mechanical compressions with this device (mechanical CPR). Results: It was possible to complete coronary angiography with the device attached to the patient in all cases, and it was also possible to complete coronary angioplasty during mechanical CPR. In all cases, mechanical CPR provided uninterrupted chest compressions more effectively and always stable in stead of manual compressions. Although a mean blood pressure of 40mmHg in both methods, mechanical CPR was able to maintain this pressure for a long time, but manual CPR had an important reduction in mean blood pressure after two minutes of CPR in all cases. Conclusions: In conclusion, percutaneous coronary interventions are feasible concurrent with mechanical CPR using AutoPulse® in patients suffering cardiac arrest in the Cath Lab. The device provided uninterrupted chest compressions more effective than manual compressions, as well as allowed the freedom of the physicians to attempt other functions, different from CPR, during the procedures.

Influence of air temperature on ventilation rates and thermoregulation of a flying bat

1991 ◽  
Vol 260 (5) ◽  
pp. R960-R968 ◽  
Author(s):  
S. P. Thomas ◽  
D. B. Follette ◽  
A. T. Farabaugh
Keyword(s):  
Heat Loss ◽  
Minute Ventilation ◽  
Ventilation Rate ◽  
Evaporative Heat Loss ◽  
Breathing Frequency ◽  
Significant Extent ◽  
Metabolic Heat ◽  
Air Temperatures ◽  
Phyllostomus Hastatus ◽  
Ventilation Rates

To assess the involvement of the ventilatory system in thermoregulation during flight, breathing frequencies and tidal volumes were measured from three Phyllostomus hastatus undertaking steady wind tunnel flights at a constant speed over a range of air temperatures (Ta) from 17.7 to 31.1 degrees C. Mean breathing frequency was independent of Ta, and tidal volume increased only modestly with increasing Ta. Consequently, minute ventilation rate increased insignificantly over the range of Ta values investigated. Mean rectal temperature showed a direct linear relation to Ta and increased significantly from 39.1 to 41.9 degrees C over the range of Ta values investigated. The highest rectal temperatures measured from flying P. hastatus are approximately 3 degrees C less than those of flying birds. In contrast to flying birds, flying P. hastatus does not modulate its rate of respiratory evaporative heat loss to any significant extent in response to environmental heat stress and only loses an estimated 14% of its metabolic heat load by this route. Cutaneous heat loss channels must therefore be very important to these animals. Some reasons for the observed differences in the thermoregulatory responses of flying bats and birds are discussed as well as the relative advantages and limitations of each group's solutions to their thermoregulatory challenges.

scholarly journals Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042062
Author(s):  
Manuel Obermaier ◽  
Johannes B Zimmermann ◽  
Erik Popp ◽  
Markus A Weigand ◽  
Sebastian Weiterer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Chest Compressions ◽  
Term Survival ◽  
Statistical Heterogeneity ◽  
Mechanical Cpr

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysisA sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationNo ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration numberCRD42017051633.

Thoracic Spine Fracture in a Survivor of Out-of-Hospital Cardiac Arrest with Mechanical CPR

2016 ◽  
Vol 31 (6) ◽  
pp. 684-686 ◽  
Author(s):  
Robert Trevor Marshall ◽  
Hemang Kotecha ◽  
Takuyo Chiba ◽  
Joseph Tennyson
Keyword(s):  
Cardiac Arrest ◽  
Vertebral Fracture ◽  
Thoracic Spine ◽  
Spine Fracture ◽  
Chest Compressions ◽  
Publication Type ◽  
Thoracic Spine Fracture ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest ◽  
Male Survivor

AbstractThis is a report of a thoracic vertebral fracture in a 79-year-old male survivor of out-of-hospital cardiac arrest with chest compressions provided by a LUCAS 2 (Physio-Control Inc.; Lund Sweden) device. This is the first such report in the literature of a vertebral fracture being noted in a survivor of cardiac arrest where an automated compression device was used.MarshallRT, KotechaH, ChibaT, TennysonJ. Thoracic spine fracture in a survivor of out-of-hospital cardiac arrest with mechanical CPR. Prehosp Disaster Med. 2016;31(6):684–686.

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