Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Awni M. Al-Subu; Timothy A. Hacker; Jens C. Eickhoff; George Ofori-Amanfo; Marlowe W. Eldridge

doi:10.1055/s-0040-1712531

Journal of Pediatric Intensive Care, Inhaltsverzeichnis

J Pediatr Intensive Care 2021; 10(01): 031-037
DOI: 10.1055/s-0040-1712531

Original Article

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Authors

Awni M. Al-Subu

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Timothy A. Hacker

²Cardiovascular Research Center, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Jens C. Eickhoff

³Department of Biostatistics, University of Wisconsin, Madison, Wisconsin, United States
George Ofori-Amanfo

⁴Division of Pediatric Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, United States
Marlowe W. Eldridge

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Abstract

The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO₂) and the volume of CO₂ elimination (VCO₂) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO₂ and VCO₂ had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 (p < 0.001) and 0.53 (p = 0.018), respectively. However, both EtCO₂ and VCO₂ had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 (p = 0.484) (95% confidence interval [CI], –0.51–0.83) and 0.25 (p = 0.566) (95% CI, –0.55–0.81), respectively. EtCO₂ and VCO₂ increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO₂ and VCO₂ and CO were weak 0.20 (p = 0.646) (95% CI, −0.59–0.79), and 0.27 (p = 0.543) (95% CI, −0.54–0.82) following epinephrine boluses. Continuous EtCO₂ and VCO₂ monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO₂ and VCO₂ to guide chest compression.

Keywords

resuscitation - end-tidal CO₂ - volumetric capnography - VCO₂ - monitoring - pediatric

Volltext

Referenzen

References
1 Alten JA, Klugman D, Raymond TT. et al. Epidemiology and outcomes of cardiac arrest in pediatric cardiac ICUs. Pediatr Crit Care Med 2017; 18 (10) 935-943
2 Becker LB, Smith DW, Rhodes KV. Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med 1993; 22 (01) 86-91
3 Nichol G, Thomas E, Callaway CW. et al; Resuscitation Outcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008; 300 (12) 1423-1431
4 Merchant RM, Yang L, Becker LB. et al; American Heart Association Get With The Guidelines-Resuscitation Investigators. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med 2011; 39 (11) 2401-2406
5 Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2007; 33 (02) 237-245
6 Jacobs I, Nadkarni V, Bahr J. et al; International Liaison Committee on Resuscitation; American Heart Association; European Resuscitation Council; Australian Resuscitation Council; New Zealand Resuscitation Council; Heart and Stroke Foundation of Canada; InterAmerican Heart Foundation; Resuscitation Councils of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 2004; 110 (21) 3385-3397
7 Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med 2012; 30 (08) 1630-1638
8 McDonald JL. Systolic and mean arterial pressures during manual and mechanical CPR in humans. Ann Emerg Med 1982; 11 (06) 292-295
9 Paradis NA, Martin GB, Rivers EP. et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990; 263 (08) 1106-1113
10 Babbs CF, Voorhees WD, Fitzgerald KR, Holmes HR, Geddes LA. Relationship of blood pressure and flow during CPR to chest compression amplitude: evidence for an effective compression threshold. Ann Emerg Med 1983; 12 (09) 527-532
11 Xu J, Li C, Li Y. et al. Influence of chest compressions on circulation during the peri-cardiac arrest period in porcine models. PLoS One 2016; 11 (05) e0155212
12 Botte A, Leclerc F, Riou Y. et al. Evaluation of a noninvasive cardiac output monitor in mechanically ventilated children. Pediatr Crit Care Med 2006; 7 (03) 231-236
13 Eckstein M, Hatch L, Malleck J, McClung C, Henderson SO. End-tidal CO₂ as a predictor of survival in out-of-hospital cardiac arrest. Prehosp Disaster Med 2011; 26 (03) 148-150
14 Sheak KR, Wiebe DJ, Leary M. et al. Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest. Resuscitation 2015; 89: 149-154
15 Lewis LM, Stothert J, Standeven J, Chandel B, Kurtz M, Fortney J. Correlation of end-tidal CO₂ to cerebral perfusion during CPR. Ann Emerg Med 1992; 21 (09) 1131-1134
16 Morisaki H, Takino Y, Kobayashi H, Ando Y, Ichikizaki K. [End-tidal carbon dioxide concentration during cardiopulmonary resuscitation in patients with pre-hospital cardiac arrest]. Masui 1991; 40 (07) 1048-1051
17 Kallet RH, Daniel BM, Garcia O, Matthay MA. Accuracy of physiologic dead space measurements in patients with acute respiratory distress syndrome using volumetric capnography: comparison with the metabolic monitor method. Respir Care 2005; 50 (04) 462-467
18 Leturiondo M, Ruiz de Gauna S, Ruiz JM. et al. Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation. Resuscitation 2018; 124: 63-68
19 Young A, Marik PE, Sibole S, Grooms D, Levitov A. Changes in end-tidal carbon dioxide and volumetric carbon dioxide as predictors of volume responsiveness in hemodynamically unstable patients. J Cardiothorac Vasc Anesth 2013; 27 (04) 681-684
20 Suarez-Sipmann F, Bohm SH, Tusman G. Volumetric capnography: the time has come. Curr Opin Crit Care 2014; 20 (03) 333-339
21 Al-Subu AM, Hacker TA, Eickhoff JC, Ofori-Amanfo G, Eldridge MW. Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model. J Clin Monit Comput 2020; 34 (01) 63-70
22 Sandroni C, De Santis P, D'Arrigo S. Capnography during cardiac arrest. Resuscitation 2018; 132: 73-77
23 Stine CN, Koch J, Brown LS, Chalak L, Kapadia V, Wyckoff MH. Quantitative end-tidal CO₂ can predict increase in heart rate during infant cardiopulmonary resuscitation. Heliyon 2019; 5 (06) e01871
24 Hamrick JL, Hamrick JT, Lee JK, Lee BH, Koehler RC, Shaffner DH. Efficacy of chest compressions directed by end-tidal CO2 feedback in a pediatric resuscitation model of basic life support. J Am Heart Assoc 2014; 3 (02) e000450
25 Al-Subu A, Jooste E, Hornik CP, Fleming GA, Cheifetz IM, Ofori-Amanfo G. Correlation between minute carbon dioxide elimination and pulmonary blood flow in single-ventricle patients after stage 1 palliation and 2-ventricle patients with intracardiac shunts: a pilot study. Paediatr Anaesth 2018; 28 (07) 618-624
26 Berg RA, Henry C, Otto CW. et al. Initial end-tidal CO₂ is markedly elevated during cardiopulmonary resuscitation after asphyxial cardiac arrest. Pediatr Emerg Care 1996; 12 (04) 245-248
27 Lin QM, Fang XS, Zhou LL, Fu Y, Zhu J, Huang ZT. Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest. World J Emerg Med 2014; 5 (02) 116-121
28 Lui CT, Poon KM, Tsui KL. Abrupt rise of end tidal carbon dioxide level was a specific but non-sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest. Resuscitation 2016; 104: 53-58
29 Hamrick JT, Hamrick JL, Bhalala U. et al. End-tidal CO₂-guided chest compression delivery improves survival in a neonatal asphyxial cardiac arrest model. Pediatr Crit Care Med 2017; 18 (11) e575-e584
30 Burnett AM, Segal N, Salzman JG, McKnite MS, Frascone RJ. Potential negative effects of epinephrine on carotid blood flow and ETCO₂ during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation 2012; 83 (08) 1021-1024
31 Martin GB, Gentile NT, Paradis NA, Moeggenberg J, Appleton TJ, Nowak RM. Effect of epinephrine on end-tidal carbon dioxide monitoring during CPR. Ann Emerg Med 1990; 19 (04) 396-398
32 Hardig BM, Götberg M, Rundgren M. et al. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: a randomised porcine study. Resuscitation 2016; 101: 77-83
33 Isserles SA, Breen PH. Can changes in end-tidal PCO₂ measure changes in cardiac output?. Anesth Analg 1991; 73 (06) 808-814
34 Meaney PA, Bobrow BJ, Mancini ME. et al; CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013; 128 (04) 417-435
35 Morgan RW, French B, Kilbaugh TJ. et al. A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: diastolic blood pressure versus end-tidal carbon dioxide. Resuscitation 2016; 104: 6-11
36 Sanders AB, Atlas M, Ewy GA, Bragg S, Kern KB. Expired PCO₂ as an index of the coronary perfusion-pressure. Clin Res 1984; 32 (01) A12-A12
37 von Planta M, von Planta I, Weil MH, Bruno S, Bisera J, Rackow EC. End tidal carbon dioxide as an haemodynamic determinant of cardiopulmonary resuscitation in the rat. Cardiovasc Res 1989; 23 (04) 364-368
38 Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation: 2011. Respir Care 2011; 56 (04) 503-509

Zusatzmaterial

Supplementary Material (PDF)