Abstract 13110: Novel Application of Thoracic Impedance to Characterize Ventilations During Cardiopulmonary Resuscitation in the Pragmatic Airway Resuscitation Trial

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Michelle Nassal ◽  
Xabier Jaureguibeitia ◽  
Elisabete Aramendi ◽  
Unai Irusta ◽  
Ashish R Panchal ◽  
...  
Keyword(s):  
Signal Processing ◽  
Cardiopulmonary Resuscitation ◽  
Adaptive Filtering ◽  
Laryngeal Tube ◽  
Thoracic Impedance ◽  
Chest Compressions ◽  
Controlled Ventilation ◽  
Novel Approach ◽  
Minute Duration ◽  
End Tidal

Introduction: Controlled ventilation is important in OHCA resuscitation, but there are few validated methods for accurate detection of ventilations. We sought to utilize changes in thoracic impedance (TI) to characterize resuscitation ventilations in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed CPR process files collected from adult OHCA enrolled in PART. We limited the analysis to cases with simultaneous capnography ventilation recordings at the Dallas-Ft Worth site. We identified ventilation waveforms in the thoracic impedance signal by applying automated signal processing with adaptive filtering techniques to remove overlying artifacts from chest compressions. We correlated detected ventilations with the end-tidal capnography signal. We determined the amplitudes (Ai, Ae) and durations (Di, De) of both insufflation and exhalation phases of the ventilation impedance signal (Figure 1). We compared differences between laryngeal tube (LT) and endotracheal intubation (ETI) airway management during mechanical or manual chest compressions using Mann-Whitney U-test. Results: We included 303 CPR process cases in the analysis; 209 manual (77 ETI, 132 LT), 94 mechanical (41 ETI, 53 LT). Ventilation Ai and Ae were higher for ETI than LT in both manual (ETI: Ai 0.71Ω, Ae 0.70Ω vs LT: Ai 0.46Ω Ae 0.45Ω, p<0.01 respectively) and mechanical chest compressions (ETI: Ai 1.22Ω, Ae 1.14Ω VS LT: Ai 0.74Ω, Ae 0.68Ω, p<0.01 respectively). Ventilations per minute, duration of TI amplitude insufflation and exhalation did not differ among groups. Conclusion: Compared with LT, ETI thoracic impedance ventilation insufflation and exhalation amplitude were higher while duration did not differ. TI may provide a novel approach to characterizing ventilation during OHCA.

Can thoracic impedance monitor the depth of chest compressions during out-of-hospital cardiopulmonary resuscitation?

Resuscitation ◽  
2014 ◽  
Vol 85 (5) ◽  
pp. 637-643 ◽  
Author(s):  
Erik Alonso ◽  
Digna González-Otero ◽  
Elisabete Aramendi ◽  
Sofía Ruiz de Gauna ◽  
Jesús Ruiz ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Thoracic Impedance ◽  
Chest Compressions

scholarly journals Aerosol-spread during chest compressions in a cadaver model

2020 ◽  
Author(s):  
Matthias Ott ◽  
Alfio Milazzo ◽  
Stefan Liebau ◽  
Christina Jaki ◽  
Tobias Schilling ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Endotracheal Tube ◽  
Laryngeal Tube ◽  
Chest Compressions ◽  
Artificial Airway ◽  
Human Cadavers ◽  
Staff Protection ◽  
Remarkable Reduction

AbstractObjectiveTo evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about aerosol-spread is vital during the SARS-CoV-2-Pandemic.MethodsTo evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-spread during chest compressions the same way. We did recordings with undergoing compression-only-CPR, with a surgical mask and with an inserted laryngeal tube with and without a connected airway filter.ResultsMost aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask deflected the spread. Inserting a laryngeal tube connected to an airway filter lead to a remarkable reduction of aerosol-spread.ConclusionThe early insertion of a laryngeal tube connected to an airway filter before starting chest compression may be good for two things – the treatment of hypoxemia as the likeliest cause of cardiac arrest and for staff protection during CPR.

scholarly journals Correlation between end-tidal carbon dioxide and the degree of compression of heart cavities measured by transthoracic echocardiography during cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Roman Skulec ◽  
Petr Vojtisek ◽  
Vladimir Cerny
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Transthoracic Echocardiography ◽  
Life Support ◽  
Compression Index ◽  
Chest Compressions ◽  
End Tidal Carbon Dioxide ◽  
End Tidal ◽  
Hospital Cardiac Arrest

Abstract Background The concept of personalized cardiopulmonary resuscitation (CPR) requires a parameter that reflects its hemodynamic efficiency. While intra-arrest ultrasound is increasingly implemented into the advanced life support, we realized a pre-hospital clinical study to evaluate whether the degree of compression of the right ventricle (RV) and left ventricle (LV) induced by chest compressions during CPR for out-of-hospital cardiac arrest (OHCA) and measured by transthoracic echocardiography correlates with the levels of end-tidal carbon dioxide (EtCO2) measured at the time of echocardiographic investigation. Methods Thirty consecutive patients resuscitated for OHCA were included in the study. Transthoracic echocardiography was performed from a subcostal view during ongoing chest compressions in all of them. This was repeated three times during CPR in each patient, and EtCO2 levels were registered. From each investigation, a video loop was recorded. Afterwards, maximal and minimal diameters of LV and RV were obtained from the recorded loops and the compression index of LV (LVCI) and RV (RVCI) was calculated as (maximal − minimal/maximal diameter) × 100. Maximal compression index (CImax) defined as the value of LVCI or RVCI, whichever was greater was also assessed. Correlations between EtCO2 and LVCI, RVCI, and CImax were expressed as Spearman’s correlation coefficient (r). Results Evaluable echocardiographic records were found in 18 patients, and a total of 52 measurements of all parameters were obtained. Chest compressions induced significant compressions of all observed cardiac cavities (LVCI = 20.6 ± 13.8%, RVCI = 34.5 ± 21.6%, CImax = 37.4 ± 20.2%). We identified positive correlation of EtCO2 with LVCI (r = 0.672, p < 0.001) and RVCI (r = 0.778, p < 0.001). The strongest correlation was between EtCO2 and CImax (r = 0.859, p < 0.001). We identified that a CImax cut-off level of 17.35% predicted to reach an EtCO2 level > 20 mmHg with 100% sensitivity and specificity. Conclusions Evaluable echocardiographic records were reached in most of the patients. EtCO2 positively correlated with all parameters under consideration, while the strongest correlation was found between CImax and EtCO2. Therefore, CImax is a candidate parameter for the guidance of hemodynamic-directed CPR. Trial registration ClinicalTrial.gov, NCT03852225. Registered 21 February 2019 - Retrospectively registered.

Abstract 203: Thoracic Impedance Reflects Differences Between Endotracheal and Laryngeal Advanced Airway During Mechanical Chest Compressions

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Xabier Jaureguibeitia ◽  
Elisabete Aramendi ◽  
Unai Irusta ◽  
Ahamed H Idris ◽  
Henry E Wang
Keyword(s):  
Dead Space ◽  
Compression Therapy ◽  
Laryngeal Tube ◽  
Thoracic Impedance ◽  
Chest Compressions ◽  
Wilcoxon Rank Sum Test ◽  
Advanced Airway ◽  
Management Techniques ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Background: Ventilations during out-of-hospital cardiac arrest (OHCA) produce thoracic impedance(TI) waveforms due to air volume changes in the lungs. Different airway management techniques, i.e. laryngeal tube (LT) and endotracheal intubation (ETI), may produce distinct TI waveforms as a result of different air flows and dead space volumes. Methods: Adult OHCA cases from the Pragmatic Airway Resuscitation Trial were analyzed. Cases recorded with Philips MRx monitor-defibrillators and treated with LUCAS mechanical CPR devices were considered, ensuring homogeneous TI acquisition and compression therapy. Impedance and capnogram signal intervals were extracted after successful airway insertion and during ongoing chest compressions. Ventilations were confirmed in the capnogram, and the associated TI waveforms were analyzed. Adaptive filtering was applied to remove compression artifacts, and the amplitudes (A i , A e ) and durations (D i , D e ) of the insufflation and exhalation phases were computed (see Figure). Each case was characterized by its observed median values. Differences between airway groups were assessed with a Wilcoxon rank sum test. Results: Data from 100 OHCA cases (57 LT and 43 ETI) were analyzed, totaling 10348 ventilations, with median (IQR) of 87 (51 - 146) ventilations per case. Median TI amplitudes for ETI and LT groups showed significant differences (p<0.05), with 1.1 (0.7 - 1.8) Ω and 0.7 (0.3 - 1.3) Ω for A i , and 1.0 (0.7 - 1.6) Ω and 0.6 (0.3 - 1.2) Ω for A e . No significant differences were observed for phase durations, 1.6 (1.3 - 2.0) s and 1.6 (1.2 - 1.8) s for D i , and 2.3 (1.8 - 3.3) s and 2.6 (2.0 - 3.3) s for D e . Conclusions: Significant differences on ventilation impedance waveform amplitudes were observed between patients treated with ETI and LT. This might be related to higher insufflated air volumes for ETI or larger dead space volumes for LT.

A shock advisory algorithm to analyse through chest compressions for reducing interruptions during cardiopulmonary resuscitation

Resuscitation ◽  
2017 ◽  
Vol 118 ◽  
pp. e6 ◽  
Author(s):  
Chenguang Liu ◽  
Stacy Gehman ◽  
Dawn Jorgenson ◽  
Tom Lyster ◽  
Jason Coult ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Chest Compressions

Chest compression efficacy of child resuscitators

2021 ◽  
Vol 13 (11) ◽  
pp. 448-455
Author(s):  
Tiffany Wai Shan Lau ◽  
Anthony Robert Lim ◽  
Kyra Anne Len ◽  
Loren Gene Yamamoto
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Minimum Weight ◽  
Success Rates ◽  
Compression Force ◽  
Chest Compressions ◽  
Traditional Methods ◽  
Video Review ◽  
Brief Training

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

2021 ◽  
pp. 1-6
Author(s):  
Chuenruthai Angkoontassaneeyarat ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
Pemika Rukthai ◽  
Marisa Seanpan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Health Care Providers ◽  
Care Providers ◽  
Chest Compressions ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

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