Abstract 13412: Gender Based Differences in Duration of Cardiopulmonary Resuscitation in the Inpatient Setting

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Anna Baillie ◽  
Rebecca Sell ◽  
Victoria Speck ◽  
Gabriel Wardi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Retrospective Chart Review ◽  
Spontaneous Circulation ◽  
Inpatient Setting ◽  
Female Patients ◽  
Shockable Rhythm ◽  
Patient Gender ◽  
Significant Difference ◽  
Male Patients

Introduction: The decision to terminate cardiopulmonary resuscitation (CPR) prior to return of spontaneous circulation (ROSC) may be impacted by resuscitation parameters or by patient demographics. Studies show that longer resuscitation efforts have a higher likelihood of ROSC and survival to discharge. It is unclear if gender of the code leader and the patient may be associated with duration of unsuccessful CPR attempt. Methods: Retrospective chart review of inpatient CA that occurred at the UC San Diego Health System between 2011-2019. All adult inpatients with an index cardiac arrest who expired within three days of admission were included. Exclusion criteria included patients who achieved ROSC, CA that occurred outside of the wards or ICU, those with active pre-arrest DNR status, and patients with CA > 3 days after admission (done to minimize provider bias based on prior knowledge of the patient). Data were identified from an internal cardiac arrest quality improvement database. Patient gender was self-reported and code leader gender was identified. Primary outcome was duration of resuscitation efforts. To determine differences in duration of CPR between code leader and patient gender a one-sided ANOVA test was used. A p value < 0.05 was considered statistically significant. Results: We identified 91 patients between 2011 and 2019 that met inclusion criteria. Thirty-eight patients (41.8%) identified as female, fifty-three identified as male (58.2%), the average age was 62.7 years old, and seventeen (18.7%) had initial shockable rhythm. Thirty (33%) of the code leaders identified as female and sixty-one (67%) identified as male. Average duration of CPR was 31.6 minutes (2 - 135 minutes) for male patients with male code leader, 32.2 minutes (9 - 71 minutes) for male patients with female code leader, 27.0 minutes (7 - 60 minutes) for female patients with female code leader, and 33.7 minutes (10 - 73 minutes) for female patients with male code leader. No significant difference in duration of unsuccessful CPR attempt associated with gender of code leader and gender of patient in ANOVA analysis was found (p = 0.512). Conclusions: We did not identify a significant association between code leader and patient gender on duration of CPR in the inpatient setting.

scholarly journals Utility of opening rhythms in predicting time to return of spontaneous circulation in cardiac arrest victims in a resource constrained setting: a single centre prospective observational study

2019 ◽  
Vol 7 (12) ◽  
pp. 4709
Author(s):  
Appu Suseel ◽  
Siju V. Abraham ◽  
Radha K. R.
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Resource Constrained ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Mean Time

Background: Time to ROSC has been shown to be an important and independent predictor of mortality and adverse neurological outcome. In resource limited situations judicious deployment of resources is crucial. Prognostication of arrest victims may aid in better resource allocation. This study aimed to assess the time to Return of Spontaneous Circulation (ROSC) in cardiac arrest victims and its relationship with opening rhythms.Methods: Consecutive victims of cardiopulmonary arrest who presented to a single center were included in this study if they met the inclusion and exclusion criteria. Time at which opening rhythm was analyzed and time at which ROSC was achieved was noted. This was done for all cases and mean time to ROSC was calculated for each opening rhythm. All those patients who achieved ROSC were followed up till hospital discharge or death.  Primary outcome measured was achievement of ROSC and the secondary outcome was the survival to hospital discharge.Results: A sample size of 100 was calculated to yield a significance criterion of 0.05 and a power of 0.80 based on prior studies. Out of 100 patients studied. 58% had shockable rhythms and 42% had non-shockable rhythms.  Mean time to ROSC for shockable rhythm was 5.55±3.51 minutes, and for non-shockable rhythm is 17.29±4.18 minutes.  There was a statistically significant difference between opening rhythms in terms of survival to hospital discharge (p=0.0329).Conclusions: Cardiac arrests with shockable rhythms attained ROSC faster when compared to nonshockable rhythms. Shockable rhythms have a better survival to hospital discharge when compared to shockable rhythms. Opening rhythms may aid the clinician in better utility of resources in a resource constrained setting.

scholarly journals The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Renata Maria de Oliveira Botelho ◽  
Cássia Regina Vancini Campanharo ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
Aécio Flávio Teixeira de Góis ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Significant Difference ◽  
Service Data

ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

scholarly journals Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243757
Author(s):  
Joongyub Lee ◽  
Woojoo Lee ◽  
Yu Jin Lee ◽  
Hyunman Sim ◽  
Won Kyung Lee
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Directed Acyclic Graph ◽  
Neurological Recovery ◽  
Outcome Variable ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Male Patients ◽  
Unbiased Estimates ◽  
Hospital Cardiac Arrest

Introduction Few studies have focused on enhancing causality and yielding unbiased estimates on the effectiveness of bystander cardiopulmonary resuscitation (BCPR) on the outcomes of out-of-hospital cardiac arrest (OHCA) in a real-world setting. Therefore, this study evaluated the effect of BCPR on the outcomes of OHCA and its differences according to the characteristics of OHCA. Methods This study enrolled all patients with OHCA of cardiac etiology treated by emergency medical services (EMS) in Korea from 2012 to 2015. The endpoints were survival and neurological recovery at discharge, and the main exposure was BCPR conducted by a layperson. The effect of BCPR was analyzed after adjusting for confounders, determined using a directed acyclic graph, by inverse probability of treatment weighting (IPTW) and model-based standardization (STR). Moreover, differences in subgroups and time trends were evaluated. Results Among 10,505 eligible patients after excluding those with missing data on BCPR, 7,721 patients received BCPR, accounting for 74.3% of EMS-treated OHCA patients. BCPR increased the odds of survival and good neurological recovery at discharge by 1.67- (95% confidence interval (CI): 1.44–1.93) and 1.93- (95% CI: 1.56–2.39) fold, respectively, in the IPTW analysis. These findings were comparable to those obtained with STR. The odds ratios were 2.39 (95% CI: 1.91–2.94) and 2.70 (95% CI: 1.94–3.41), respectively, in the sensitivity analysis of the missing BCPR information considering confounders and the outcome variable. However, the effect of qualified BCPR was not evenly distributed, and it did not increase with time. BCPR was likely to be more effective in male patients aged <65 years, those who experienced an OHCA in a private place or non-capital region, and those with shockable rhythm at the scene. Conclusion Based on data from a nationwide registry, the estimated effect of BCPR on survival and neurological recovery was moderate and did not improve from 2012 to 2015.

Abstract 206: Cardiopulmonary Resuscitation Process Measures Associated With Return of Spontaneous Circulation in Non-Shockable Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jose M Juarez ◽  
Allison C Koller ◽  
Robert H Schmicker ◽  
Seo Young Park ◽  
David D Salcido ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Duty Cycle ◽  
Spontaneous Circulation ◽  
Research Network ◽  
Process Measures ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Purpose: Survival rates after non-shockable out-of-hospital cardiac arrest (OHCA) remain low despite advances in resuscitation. Cardiopulmonary resuscitation (CPR) process measures may inform treatment strategies. We hypothesized that CPR process measures would be associated with return of spontaneous circulation (ROSC) and patient electrocardiogram (ECG) transitions. Methods: We obtained defibrillator monitor data for emergency medical service (EMS)-treated non-shockable OHCA from the Resuscitation Outcomes Consortium (ROC), an OHCA research network (U.S./Canada). We extracted ECG data from EMS defibrillator files and parsed cases into compression-free analyzable segments using custom MATLAB software. Two data abstractors classified segment rhythms as PEA, asystole, ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), or ROSC. We calculated CPR process measures (average rate, depth, duration, leaning proportion, chest compression fraction, and duty cycle) for CPR bouts preceding every ECG segment. We used mixed effects models controlling for subject to test associations between individual CPR process measures and the bout-level outcomes ROSC and shockable rhythm. Results: We analyzed 1893 cases consisting of 7981 CPR bouts. Case initial rhythms were asystole (68.2%), PEA (24.9%), or NSA-AED (6.9%). Segment rhythm classifications were asystole (78.1%), PEA (20.4%), ROSC (5.5%), VF (1.4%), and PVT (0.07%). Regression model results are shown in Table 1. Chest compression fraction was most strongly associated with ROSC and shockable rhythm. Depth was also associated with shockable rhythm. Leaning proportion and duty cycle were not associated with either outcome. Conclusions: In cases of non-shockable OHCA, CPR quality measures were associated with ROSC and transition to a shockable rhythm at the bout level.

Infant and Pediatric Cardiopulmonary Resuscitation

2021 ◽  
pp. 183-190
Author(s):  
Sarah Nizamuddin
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Rate Of Return ◽  
High Quality ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Level Of Importance

High-quality cardiopulmonary resuscitation (CPR) in children with cardiac arrest is vitally important to increase the chance of survival. The rate of return of spontaneous circulation from in-hospital cardiac arrests has improved between 2001 and 2013, from 39% to 77%. In adults, cardiac arrest is most commonly due to primary cardiac causes. In contrast, the cause of pediatric cardiac arrest is often asphyxia resulting in hypoxia. Because of this difference, there is a greater level of importance given to ventilation during infant and pediatric CPR. After recognition of the loss of pulse or blood pressure, quick initiation of CPR is necessary to provide blood flow to vital organs. Ensuring high-quality cardiopulmonary resuscitation in pediatric patients requires knowledge of the appropriate equipment, medications, and procedures. Quick recognition of the loss of spontaneous circulation should trigger an immediate call for help and initiation of chest compressions. Ventilation should be supported, and defibrillation should be performed when the patient is in a shockable rhythm. Epinephrine and other medications may also be required.

scholarly journals Gender Based Differences in Outcomes among Resuscitated Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Author(s):  
Purav Mody ◽  
Ambarish Pandey ◽  
Arthur S. Slutsky ◽  
Matthew W. Segar ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Do Not Resuscitate ◽  
Logistic Regression Models ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Resuscitated Patients ◽  
Gender Based ◽  
Hospital Cardiac Arrest

Background: Studies examining gender-based differences in outcomes of out-of-hospital cardiac arrest patients have demonstrated that despite a higher likelihood of return of spontaneous circulation, women do not have higher survival. Methods: Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the Continuous Chest Compression trial were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time and duration of resuscitation. Do Not Resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in post resuscitation outcomes were modified by baseline prognosis. The analysis was replicated among Amiodarone, Lidocaine, or Placebo Cardiac Arrest trial participants. Results: Among 4,875 successfully resuscitated patients, 1,825 (37.4%) were women and 3,050 (62.6%) were men. Women were older (67.5 vs. 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% vs. 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% vs. 64.5%) or had shockable rhythm (24.3% vs. 44.6%, p<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% vs. 32.1%, p=0.009) and had WLST (32.8% vs. 29.8%, p=0.03). Discharge survival was significantly lower in women (22.5% vs. 36.3%, p<0.001, adjusted odds ratio [OR] 0.78, 95% confidence interval [C.I.] 0.66 - 0.93, p=0.005). The association between gender and discharge survival was modified by DNR and WLST order status such that women had significantly reduced discharge survival among patients who were not made DNR (31.3% vs. 49.9%, p=0.005, adjusted OR 0.74, 95% C.I. 0.60 - 0.91) or did not have WLST (32.3% vs. 50.7%, p=0.002, adjusted OR 0.73, 95% C.I. 0.60 - 0.89). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% vs. 7.4%, p=0.90) or had WLST (2.8% vs. 2.4%, p=0.93). Consistent patterns of association between gender and post-resuscitation outcomes were observed in the secondary cohort. Conclusions: Among resuscitated out-of-hospital cardiac arrest patients, discharge to survival was significantly lower in women compared with men especially among patients considered to have a favorable prognosis.

Abstract 204: Conventional vs. Compression-Only Cardiopulmonary Resuscitation for Geriatric Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiroki Ueyama ◽  
Yosuke Homma ◽  
Hiroyasu Shimizu ◽  
Tetsuya Inoue ◽  
Hiraku Funakoshi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Scale Score ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Category Scale ◽  
Performance Category ◽  
Adjusted Analysis ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: Compression-only cardiopulmonary resuscitation (CPR) and conventional CPR (30:2, chest compression and rescue breathing) performed by bystanders are known to have similar outcomes in adults. This study aimed to investigate if this difference is applicable in geriatric populations as well. Methods: We conducted a prospective observational study using the All-Japan Utstein Registry to enroll geriatric patients (≥75 years) who experienced out-of-hospital cardiac arrest that was witnessed by bystanders in Japan from January 1, 2009 to December 31, 2013. The primary outcome was favorable neurological function 1 month after the event, which was defined as a Cerebral Performance Category Scale score of 1 or 2. The secondary outcomes were return of spontaneous circulation (ROSC), 1-month survival, and favorable overall function 1 month after the event, which was defined as an Overall Performance Category Scale score of 1 or 2. Outcomes of compression-only CPR and conventional CPR were compared using multivariable logistic regression analyses. Results: Of the 58,072 enrolled patients, 13,248 (22.8%) received conventional CPR whereas 44,824 (77.2%) received compression-only CPR. Favorable neurological outcomes were achieved in 708 (5.3%) patients receiving CPR and 1799 (4.0%) patients receiving compression-only CPR. A crude analysis of neurologically favorable survival revealed superiority of conventional CPR [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.24–1.48; P < 0.001]], but it was no longer statistically significant after multivariable adjustment (OR, 1.09; 95% CI, 0.93–1.27; P = 0.29). Similarly, multivariable adjusted analysis of favorable overall function survival showed no significant difference (OR, 1.08; 95% CI, 0.92–1.26; P = 0.38) between conventional and compression-only CPR. Conventional CPR demonstrated better outcomes in multivariable adjusted analysis of ROSC and 1 month survival (OR, 1.30; 95% CI, 1.22–1.40; P < 0.001 and OR, 1.13. 95% CI, 1.04–1.23; P = 0.003, respectively). Conclusions: The superiority of conventional CPR in geriatric populations was not proven. Thus, we conclude that compression-only CPR is an adequate means of resuscitation in geriatric populations.

Effect of chest-compression-only bystander cardiopulmonary resuscitation on the likelihood of initial shockable rhythm after out-of-hospital cardiac arrest: a propensity matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Funada ◽  
Y Goto ◽  
T Maeda ◽  
H Okada ◽  
M Takamura
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr

Abstract Background/Introduction Shockable rhythm after cardiac arrest is highly expected after early initiation of bystander cardiopulmonary resuscitation (CPR) owing to increased coronary perfusion. However, the relationship between bystander CPR and initial shockable rhythm in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that chest-compression-only CPR (CC-CPR) before emergency medical service (EMS) arrival has an equivalent effect on the likelihood of initial shockable rhythm to the standard CPR (chest compression plus rescue breathing [S-CPR]). Purpose We aimed to examine the rate of initial shockable rhythm and 1-month outcomes in patients who received bystander CPR after OHCA. Methods The study included 59,688 patients (age, ≥18 years) who received bystander CPR after an OHCA with a presumed cardiac origin witnessed by a layperson in a prospectively recorded Japanese nationwide Utstein-style database from 2013 to 2017. Patients who received public-access defibrillation before arrival of the EMS personnel were excluded. The patients were divided into CC-CPR (n=51,520) and S-CPR (n=8168) groups according to the type of bystander CPR received. The primary end point was initial shockable rhythm recorded by the EMS personnel just after arrival at the site. The secondary end point was the 1-month outcomes (survival and neurologically intact survival) after OHCA. In the statistical analyses, a Cox proportional hazards model was applied to reflect the different bystander CPR durations before/after propensity score (PS) matching. Results The crude rate of the initial shockable rhythm in the CC-CPR group (21.3%, 10,946/51,520) was significantly higher than that in the S-CPR group (17.6%, 1441/8168, p&lt;0.0001) before PS matching. However, no significant difference in the rate of initial shockable rhythm was found between the 2 groups after PS matching (18.3% [1493/8168] vs 17.6% [1441/8168], p=0.30). In the Cox proportional hazards model, CC-CPR was more negatively associated with the initial shockable rhythm before PS matching (unadjusted hazards ratio [HR], 0.97; 95% confidence interval [CI], 0.94–0.99; p=0.012; adjusted HR, 0.92; 95% CI, 0.89–0.94; p&lt;0.0001) than S-CPR. After PS matching, however, no significant difference was found between the 2 groups (adjusted HR of CC-CPR compared with S-CPR, 0.97; 95% CI, 0.94–1.00; p=0.09). No significant differences were found between C-CPR and S-CPR in the 1-month outcomes after PS matching as follows, respectively: survival, 8.5% and 10.1%; adjusted odds ratio, 0.89; 95% CI, 0.79–1.00; p=0.07; cerebral performance category 1 or 2, 5.5% and 6.9%; adjusted odds, 0.86; 95% CI, 0.74–1.00; p=0.052. Conclusions Compared with S-CPR, the CC-CPR before EMS arrival had an equivalent multivariable-adjusted association with the likelihood of initial shockable rhythm in the patients with OHCA due to presumed cardiac causes that was witnessed by a layperson. Funding Acknowledgement Type of funding source: None

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

scholarly journals Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tiffany S. Ko ◽  
Constantine D. Mavroudis ◽  
Ryan W. Morgan ◽  
Wesley B. Baker ◽  
Alexandra M. Marquez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hemoglobin Concentration ◽  
Spontaneous Circulation ◽  
Youden Index ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Non Invasive ◽  
Tissue Optical Properties ◽  
Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

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