@article{aafe6f2d2f7842b2aa865a5e9b56f278,
title = "Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest",
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 (ETCO2) 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 ETCO2 and CPR characteristics during clinical resuscitation care. Methods: Multicenter cohort study of 583 in- and out-of-hospital cardiac arrests with time-synchronized ETCO2 and CPR performance data captured between 4/2006 and 5/2013. ETCO2, 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 ETCO2. For every 10mm increase in depth, ETCO2 was elevated by 1.4mmHg (p<.001). For every 10 breaths/min increase in ventilation rate, ETCO2 was lowered by 3.0mmHg (p<.001). CC rate was not a predictor of ETCO2 over the dynamic range of actual CC delivery. Case-averaged ETCO2 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: ETCO2 values generated during CPR were statistically associated with CC depth and ventilation rate. Further studies are needed to assess ETCO2 as a potential tool to guide care.",
keywords = "Capnography, Cardiopulmonary resuscitation, End-tidal carbon dioxide, Sudden cardiac arrest",
author = "Sheak, {Kelsey R.} and Wiebe, {Douglas J.} and Marion Leary and Saeed Babaeizadeh and Yuen, {Trevor C.} and Dana Zive and Owens, {Pamela C.} and Edelson, {Dana P.} and Daya, {Mohamud R.} and Idris, {Ahamed H.} and Abella, {Benjamin S.}",
note = "Funding Information: Dr. Abella reports research funding from the Medtronic Foundation, the National Heart, Lung and Blood Institute, the Travelers Foundation, and Stryker Medical. He also reports honoraria from Medivance Corporation, equity in Resuscor LLC and consulting from HeartSine Technologies Ltd. Ms. Leary reports research funding from the American Heart Association and equity in Resuscor LLC. Dr. Babaeizadeh reports Philips Healthcare as his full-time employer and is a stockholder in Philips Healthcare. Dr. Edelson reports research funding from the National Heart, Lung and Blood Institute, the American Heart Association and Laerdal Medical. She reports equity in Quant HC. Dr. Daya reports research funding from the National Heart, Lung, and Blood Institute and consulting for Philips Healthcare. Dr. Idris reports research funding from the National Heart, Lung and Blood Institute and the American Heart Association. The other authors declare no conflict of interest. Funding Information: We thank the prehospital and inpatient healthcare providers who delivered resuscitation care and enabled the collection of CPR performance data at each site. We are grateful for administrative assistance from Eileen McDonnell and statistical advice from Anne Grossestreuer. This work was supported by the NCRP Winter 2014 Mentored Clinical & Population Research Award from the American Heart Association ( 14CRP19990024 ) to Ms. Leary and Dr. Abella, and NIH funding via the ROC consortium to both Dr. Daya ( U01 HL077873 ) and Dr. Idris ( U01 HL 077887 ). A member of the investigative team, Dr. Babaeizadeh, is an employee of Philips Healthcare . Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd.",
year = "2015",
doi = "10.1016/j.resuscitation.2015.01.026",
language = "English (US)",
volume = "89",
pages = "149--154",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "C",
}