Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest
Background The American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end‐tidal carbon dioxide (ETCO2) or diastolic blood pressure (DBP) levels we...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-10-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009728 |
| _version_ | 1818774836210565120 |
|---|---|
| author | Caitlin E. O'Brien Michael Reyes Polan T. Santos Sophia E. Heitmiller Ewa Kulikowicz Sapna R. Kudchadkar Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner |
| author_facet | Caitlin E. O'Brien Michael Reyes Polan T. Santos Sophia E. Heitmiller Ewa Kulikowicz Sapna R. Kudchadkar Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner |
| author_sort | Caitlin E. O'Brien |
| collection | DOAJ |
| description | Background The American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end‐tidal carbon dioxide (ETCO2) or diastolic blood pressure (DBP) levels were used to guide chest compression delivery after asphyxial cardiac arrest. Methods and Results One‐ to 2‐week‐old swine underwent a 17‐minute asphyxial‐fibrillatory cardiac arrest followed by alternating 2‐minute periods of ETCO2‐guided and DBP‐guided chest compressions during 10 minutes of basic life support and 10 minutes of advanced life support. Ten animals underwent resuscitation. We found significant changes to ETCO2 and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2 level was greater during ETCO2‐guided cardiopulmonary resuscitation (26.4±5.6 versus 22.5±5.2 mm Hg; P=0.003), whereas the overall mean DBP was greater during DBP‐guided cardiopulmonary resuscitation (13.9±2.3 versus 9.4±2.6 mm Hg; P=0.003). ETCO2‐guided chest compressions resulted in a faster compression rate (149±3 versus 120±5 compressions/min; P=0.0001) and a higher intracranial pressure (21.7±2.3 versus 16.0±1.1 mm Hg; P=0.002). DBP‐guided chest compressions were associated with a higher myocardial perfusion pressure (6.0±2.8 versus 2.4±3.2; P=0.02) and cerebral perfusion pressure (9.0±3.0 versus 5.5±4.3; P=0.047). Conclusions Using the ETCO2 or DBP level to optimize chest compression delivery results in physiologic changes that are method‐specific and occur within 30 s. Additional studies are needed to develop protocols for the use of these potentially conflicting physiologic targets to improve outcomes of prolonged cardiopulmonary resuscitation. |
| first_indexed | 2024-12-18T10:47:28Z |
| format | Article |
| id | doaj.art-6746f857bc394c0593e07e46eeea5bb0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:47:28Z |
| publishDate | 2018-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6746f857bc394c0593e07e46eeea5bb02022-12-21T21:10:31ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-10-0171910.1161/JAHA.118.009728Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac ArrestCaitlin E. O'Brien0Michael Reyes1Polan T. Santos2Sophia E. Heitmiller3Ewa Kulikowicz4Sapna R. Kudchadkar5Jennifer K. Lee6Elizabeth A. Hunt7Raymond C. Koehler8Donald H. Shaffner9Department of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDDepartment of Anesthesiology/Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MDBackground The American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end‐tidal carbon dioxide (ETCO2) or diastolic blood pressure (DBP) levels were used to guide chest compression delivery after asphyxial cardiac arrest. Methods and Results One‐ to 2‐week‐old swine underwent a 17‐minute asphyxial‐fibrillatory cardiac arrest followed by alternating 2‐minute periods of ETCO2‐guided and DBP‐guided chest compressions during 10 minutes of basic life support and 10 minutes of advanced life support. Ten animals underwent resuscitation. We found significant changes to ETCO2 and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2 level was greater during ETCO2‐guided cardiopulmonary resuscitation (26.4±5.6 versus 22.5±5.2 mm Hg; P=0.003), whereas the overall mean DBP was greater during DBP‐guided cardiopulmonary resuscitation (13.9±2.3 versus 9.4±2.6 mm Hg; P=0.003). ETCO2‐guided chest compressions resulted in a faster compression rate (149±3 versus 120±5 compressions/min; P=0.0001) and a higher intracranial pressure (21.7±2.3 versus 16.0±1.1 mm Hg; P=0.002). DBP‐guided chest compressions were associated with a higher myocardial perfusion pressure (6.0±2.8 versus 2.4±3.2; P=0.02) and cerebral perfusion pressure (9.0±3.0 versus 5.5±4.3; P=0.047). Conclusions Using the ETCO2 or DBP level to optimize chest compression delivery results in physiologic changes that are method‐specific and occur within 30 s. Additional studies are needed to develop protocols for the use of these potentially conflicting physiologic targets to improve outcomes of prolonged cardiopulmonary resuscitation.https://www.ahajournals.org/doi/10.1161/JAHA.118.009728capnographycardiopulmonary resuscitationdiastolic blood pressurepediatricsphysiologic feedback |
| spellingShingle | Caitlin E. O'Brien Michael Reyes Polan T. Santos Sophia E. Heitmiller Ewa Kulikowicz Sapna R. Kudchadkar Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease capnography cardiopulmonary resuscitation diastolic blood pressure pediatrics physiologic feedback |
| title | Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest |
| title_full | Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest |
| title_fullStr | Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest |
| title_full_unstemmed | Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest |
| title_short | Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest |
| title_sort | pilot study to compare the use of end tidal carbon dioxide guided and diastolic blood pressure guided chest compression delivery in a swine model of neonatal asphyxial cardiac arrest |
| topic | capnography cardiopulmonary resuscitation diastolic blood pressure pediatrics physiologic feedback |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009728 |
| work_keys_str_mv | AT caitlineobrien pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT michaelreyes pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT polantsantos pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT sophiaeheitmiller pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT ewakulikowicz pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT sapnarkudchadkar pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT jenniferklee pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT elizabethahunt pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT raymondckoehler pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest AT donaldhshaffner pilotstudytocomparetheuseofendtidalcarbondioxideguidedanddiastolicbloodpressureguidedchestcompressiondeliveryinaswinemodelofneonatalasphyxialcardiacarrest |