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

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Abstract

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 ETCO2and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2level 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 ETCO2or 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.

Original languageEnglish (US)
Article numbere009728
JournalJournal of the American Heart Association
Volume7
Issue number19
DOIs
StatePublished - Oct 1 2018

Fingerprint

Heart Arrest
Swine
Thorax
Carbon
Blood Pressure
Cardiopulmonary Resuscitation
Cerebrovascular Circulation
Intracranial Pressure
Carbon Dioxide
Resuscitation
Perfusion
Hemodynamics
Pressure

Keywords

  • Capnography
  • Cardiopulmonary resuscitation
  • Diastolic blood pressure
  • Pediatrics
  • Physiologic feedback

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{cf4295015b5d4c05ac03c51579ab0e22,
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",
abstract = "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 ETCO2and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2level 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 ETCO2or 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.",
keywords = "Capnography, Cardiopulmonary resuscitation, Diastolic blood pressure, Pediatrics, Physiologic feedback",
author = "O’Brien, {Caitlin E.} and Michael Reyes and Santos, {Polan T.} and Heitmiller, {Sophia E.} and Ewa Kulikowicz and Kudchadkar, {Sapna R.} and Lee, {Jennifer K.} and Hunt, {Elizabeth A.} and Koehler, {Raymond C.} and Shaffner, {Donald H.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1161/JAHA.118.009728",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "19",

}

TY - JOUR

T1 - 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

AU - O’Brien, Caitlin E.

AU - Reyes, Michael

AU - Santos, Polan T.

AU - Heitmiller, Sophia E.

AU - Kulikowicz, Ewa

AU - Kudchadkar, Sapna R.

AU - Lee, Jennifer K.

AU - Hunt, Elizabeth A.

AU - Koehler, Raymond C.

AU - Shaffner, Donald H.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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 ETCO2and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2level 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 ETCO2or 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.

AB - 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 ETCO2and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2level 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 ETCO2or 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.

KW - Capnography

KW - Cardiopulmonary resuscitation

KW - Diastolic blood pressure

KW - Pediatrics

KW - Physiologic feedback

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U2 - 10.1161/JAHA.118.009728

DO - 10.1161/JAHA.118.009728

M3 - Article

C2 - 30371318

AN - SCOPUS:85055615085

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 19

M1 - e009728

ER -