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Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest

2015; Elsevier BV; Volume: 89; Linguagem: Inglês

10.1016/j.resuscitation.2015.01.026

1873-1570

Kelsey Sheak, Douglas J. Wiebe, Marion Leary, Saeed Babaeizadeh, Trevor C. Yuen, Dana Zive, Pamela Owens, Dana P. Edelson, Mohamud Daya, Ahamed H. Idris, Benjamin S. Abella,

Disaster Response and Management

Abstract Objective Cardiopulmonary resuscitation (CPR) guidelines recommend the administration of chest compressions (CC) at a standardized rate and depth without guidance from patient physiologic output. The relationship between CC performance and actual CPR-generated blood flow is poorly understood, limiting the ability to define "optimal" CPR delivery. End-tidal carbon dioxide (ETCO 2 ) has been proposed as a surrogate measure of blood flow during CPR, and has been suggested as a tool to guide CPR despite a paucity of clinical data. We sought to quantify the relationship between ETCO 2 and CPR characteristics during clinical resuscitation care. Methods Multicenter cohort study of 583 in- and out-of-hospital cardiac arrests with time-synchronized ETCO 2 and CPR performance data captured between 4/2006 and 5/2013. ETCO 2 , ventilation rate, CC rate and depth were averaged over 15-s epochs. A total of 29,028 epochs were processed for analysis using mixed-effects regression techniques. Results CC depth was a significant predictor of increased ETCO 2 . For every 10mm increase in depth, ETCO 2 was elevated by 1.4mmHg ( p <.001). For every 10 breaths/min increase in ventilation rate, ETCO 2 was lowered by 3.0mmHg ( p <.001). CC rate was not a predictor of ETCO 2 over the dynamic range of actual CC delivery. Case-averaged ETCO 2 values in patients with return of spontaneous circulation were higher compared to those who did not have a pulse restored (34.5±4.5 vs 23.1±12.9mmHg, p <.001). Conclusions ETCO 2 values generated during CPR were statistically associated with CC depth and ventilation rate. Further studies are needed to assess ETCO 2 as a potential tool to guide care.