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...

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Autores principales:	Caitlin E. O'Brien, Polan T. Santos, Ewa Kulikowicz, Shawn Adams, Jennifer K. Lee, Elizabeth A. Hunt, Raymond C. Koehler, Donald H. Shaffner
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Physiologic feedback Personalized resuscitation Paediatric cardiac arrest End-tidal carbon dioxide Chest compression rate Resuscitation algorithms Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/a519e390833d428db0318864d5835f4d
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spelling	oai:doaj.org-article:a519e390833d428db0318864d5835f4d2021-11-12T04:48:09ZUse of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine2666-520410.1016/j.resplu.2021.100174https://doaj.org/article/a519e390833d428db0318864d5835f4d2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666520421000990https://doaj.org/toc/2666-5204Aim: 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.Caitlin E. O'BrienPolan T. SantosEwa KulikowiczShawn AdamsJennifer K. LeeElizabeth A. HuntRaymond C. KoehlerDonald H. ShaffnerElsevierarticlePhysiologic feedbackPersonalized resuscitationPaediatric cardiac arrestEnd-tidal carbon dioxideChest compression rateResuscitation algorithmsSpecialties of internal medicineRC581-951ENResuscitation Plus, Vol 8, Iss , Pp 100174- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Physiologic feedback Personalized resuscitation Paediatric cardiac arrest End-tidal carbon dioxide Chest compression rate Resuscitation algorithms Specialties of internal medicine RC581-951
spellingShingle	Physiologic feedback Personalized resuscitation Paediatric cardiac arrest End-tidal carbon dioxide Chest compression rate Resuscitation algorithms Specialties of internal medicine RC581-951 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
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.
format	article
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
title	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_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_sort	use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a519e390833d428db0318864d5835f4d
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Use of an end-tidal carbon dioxide-guided algorithm during cardiopulmonary resuscitation improves short-term survival in paediatric swine

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