Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine
Aim: To evaluate an algorithm that uses an end-tidal carbon dioxide (ETCO2) target of ≥ 30 torr to guide specific changes in chest compression rate and epinephrine administration during cardiopulmonary resuscitation (CPR) in paediatric swine. Methods: Swine underwent asphyxial cardiac arrest followe...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520421000990 |
| _version_ | 1818871865555288064 |
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| author | Caitlin E. O'Brien Polan T. Santos Ewa Kulikowicz Shawn Adams Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner |
| author_facet | Caitlin E. O'Brien Polan T. Santos Ewa Kulikowicz Shawn Adams Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner |
| author_sort | Caitlin E. O'Brien |
| collection | DOAJ |
| description | Aim: To evaluate an algorithm that uses an end-tidal carbon dioxide (ETCO2) target of ≥ 30 torr to guide specific changes in chest compression rate and epinephrine administration during cardiopulmonary resuscitation (CPR) in paediatric swine. Methods: Swine underwent asphyxial cardiac arrest followed by resuscitation with either standard or ETCO2-guided algorithm CPR. The standard group received chest compressions at a rate of 100/min and epinephrine every 4 min during advanced life support consistent with the American Heart Association paediatric resuscitation guidelines. In the ETCO2-guided algorithm group, chest compression rate was increased by 10 compressions/min for every minute that the ETCO2 was < 30 torr, and the epinephrine administration interval was decreased to every 2 min if the ETCO2 remained < 30 torr. Short-term survival and physiologic data during active resuscitation were compared. Results: Short-term survival was significantly greater in the ETCO2-guided algorithm CPR group than in the standard CPR group (16/28 [57.1%] versus 4/28 [14.3%]; p = 0.002). Additionally, the algorithm group had higher predicted mean ETCO2, chest compression rate, diastolic and mean arterial pressure, and myocardial perfusion pressure throughout resuscitation. Swine in the algorithm group also exhibited significantly greater improvement in diastolic and mean arterial pressure and cerebral perfusion pressure after the first dose of epinephrine than did those in the standard group. Incidence of resuscitation-related injuries was similar in the two groups. Conclusions: Use of a resuscitation algorithm with stepwise guidance for changes in the chest compression rate and epinephrine administration interval based on a goal ETCO2 level improved survival and intra-arrest hemodynamics in this porcine cardiac arrest model. |
| first_indexed | 2024-12-19T12:29:42Z |
| format | Article |
| id | doaj.art-a519e390833d428db0318864d5835f4d |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-12-19T12:29:42Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-a519e390833d428db0318864d5835f4d2022-12-21T20:21:27ZengElsevierResuscitation Plus2666-52042021-12-018100174Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swineCaitlin E. O'Brien0Polan T. Santos1Ewa Kulikowicz2Shawn Adams3Jennifer K. Lee4Elizabeth A. Hunt5Raymond C. Koehler6Donald H. Shaffner7Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United States; Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 7302, Baltimore, MD 21287, United States; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, 2024 East Monument St., S 1-200, Baltimore, MD 21205, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United StatesDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Children’s Center, Suite 6302, Baltimore, MD 21287, United States; Corresponding author at: 1800 Orleans Street, Bloomberg Suite 6322, Baltimore, MD 21287, United States.Aim: To evaluate an algorithm that uses an end-tidal carbon dioxide (ETCO2) target of ≥ 30 torr to guide specific changes in chest compression rate and epinephrine administration during cardiopulmonary resuscitation (CPR) in paediatric swine. Methods: Swine underwent asphyxial cardiac arrest followed by resuscitation with either standard or ETCO2-guided algorithm CPR. The standard group received chest compressions at a rate of 100/min and epinephrine every 4 min during advanced life support consistent with the American Heart Association paediatric resuscitation guidelines. In the ETCO2-guided algorithm group, chest compression rate was increased by 10 compressions/min for every minute that the ETCO2 was < 30 torr, and the epinephrine administration interval was decreased to every 2 min if the ETCO2 remained < 30 torr. Short-term survival and physiologic data during active resuscitation were compared. Results: Short-term survival was significantly greater in the ETCO2-guided algorithm CPR group than in the standard CPR group (16/28 [57.1%] versus 4/28 [14.3%]; p = 0.002). Additionally, the algorithm group had higher predicted mean ETCO2, chest compression rate, diastolic and mean arterial pressure, and myocardial perfusion pressure throughout resuscitation. Swine in the algorithm group also exhibited significantly greater improvement in diastolic and mean arterial pressure and cerebral perfusion pressure after the first dose of epinephrine than did those in the standard group. Incidence of resuscitation-related injuries was similar in the two groups. Conclusions: Use of a resuscitation algorithm with stepwise guidance for changes in the chest compression rate and epinephrine administration interval based on a goal ETCO2 level improved survival and intra-arrest hemodynamics in this porcine cardiac arrest model.http://www.sciencedirect.com/science/article/pii/S2666520421000990Physiologic feedbackPersonalized resuscitationPaediatric cardiac arrestEnd-tidal carbon dioxideChest compression rateResuscitation algorithms |
| spellingShingle | Caitlin E. O'Brien Polan T. Santos Ewa Kulikowicz Shawn Adams Jennifer K. Lee Elizabeth A. Hunt Raymond C. Koehler Donald H. Shaffner Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine Resuscitation Plus Physiologic feedback Personalized resuscitation Paediatric cardiac arrest End-tidal carbon dioxide Chest compression rate Resuscitation algorithms |
| title | Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine |
| title_full | Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine |
| title_fullStr | Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine |
| title_full_unstemmed | Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine |
| title_short | Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine |
| title_sort | use of an end tidal carbon dioxide guided algorithm during cardiopulmonary resuscitation improves short term survival in paediatric swine |
| topic | Physiologic feedback Personalized resuscitation Paediatric cardiac arrest End-tidal carbon dioxide Chest compression rate Resuscitation algorithms |
| url | http://www.sciencedirect.com/science/article/pii/S2666520421000990 |
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