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Open Access 01-02-2011 | Research

The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest

Authors: Katja Lah, Miljenko Križmarić, Štefek Grmec

Published in: Critical Care | Issue 1/2011

Abstract

Introduction

Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in asphyxial arrest than in ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) cardiac arrest. In this study we sought to evaluate the pattern of PetCO2 changes in cardiac arrest caused by VF/VT and asphyxial cardiac arrest in patients who were resuscitated according to new 2005 guidelines.

Methods

The study included two cohorts of patients: cardiac arrest due to asphyxia with initial rhythm asystole or pulseless electrical activity (PEA), and cardiac arrest due to arrhythmia with initial rhythm VF or pulseless VT. PetCO2 was measured for both groups immediately after intubation and repeatedly every minute, both for patients with or without return of spontaneous circulation (ROSC). We compared the dynamic pattern of PetCO2 between groups.

Results

Between June 2006 and June 2009 resuscitation was attempted in 325 patients and in this study we included 51 patients with asphyxial cardiac arrest and 63 patients with VF/VT cardiac arrest. The initial values of PetCO2 were significantly higher in the group with asphyxial cardiac arrest (6.74 ± 4.22 kilopascals (kPa) versus 4.51 ± 2.47 kPa; P = 0.004). In the group with asphyxial cardiac arrest, the initial values of PetCO2 did not show a significant difference when we compared patients with and without ROSC (6.96 ± 3.63 kPa versus 5.77 ± 4.64 kPa; P = 0.313). We confirmed significantly higher initial PetCO2 values for those with ROSC in the group with primary cardiac arrest (4.62 ± 2.46 kPa versus 3.29 ± 1.76 kPa; P = 0.041). A significant difference in PetCO2 values for those with and without ROSC was achieved after five minutes of CPR in both groups. In all patients with ROSC the initial PetCO2 was again higher than 1.33 kPa.

Conclusions

The dynamic pattern of PetCO2 values during out-of-hospital CPR showed higher values of PetCO2 in the first two minutes of CPR in asphyxia, and a prognostic value of initial PetCO2 only in primary VF/VT cardiac arrest. A prognostic value of PetCO2 for ROSC was achieved after the fifth minute of CPR in both groups and remained present until final values. This difference seems to be a useful criterion in pre-hospital diagnostic procedures and attendance of cardiac arrest.

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Grmec S, Krizmaric M, Mally S, Kozelj A, Spindler M, Lesnik B: Utstein style analysis of out-of-hospital cardiac arrest--bystander CPR and end expired carbon dioxide. Resuscitation 2007, 72: 404-414. 10.1016/j.resuscitation.2006.07.012PubMedCrossRef

Axelsson C, Karlsson T, Axelsson AB, Herlitz J: Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end-tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA). Resuscitation 2009, 80: 1099-1103. 10.1016/j.resuscitation.2009.08.006PubMedCrossRef

Tachibana K, Imanaka H, Takeuchi M, Takauchi Y, Miyano H, Nishimura M: Noninvasive cardiac output measurement using partial carbon dioxide rebreathing is less accurate at settings of reduced minute ventilation and when spontaneous breathing is present. Anesthesiology 2003, 98: 830-837. 10.1097/00000542-200304000-00007PubMedCrossRef

Rivers EP, Martin GB, Smithline H, Rady MY, Schultz CH, Goetting MG, Appleton TJ, Nowak RM: The clinical implications of continuous central venous oxygen saturation during human CPR. Ann Emerg Med 1992, 21: 1094-1101. 10.1016/S0196-0644(05)80650-XPubMedCrossRef

Pytte M, Dorph E, Sunde K, Kramer-Johansen J, Wik L, Steen PA: Arterial blood gases during basic life support of human cardiac arrest victims. Resuscitation 2008, 77: 35-38.PubMedCrossRef

Kolar M, Krizmaric M, Klemen P, Grmec S: Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field: a prospective observational study. Crit Care 2008, 12: R115. 10.1186/cc7009PubMedPubMedCentralCrossRef

Weil MH: Partial pressure of end-tidal carbon dioxide predicts successful cardiopulmonary resuscitation in the field. Crit Care 2008, 12: 90. 10.1186/cc7090PubMedPubMedCentralCrossRef

Krizmaric M, Verlic M, Stiglic G, Grmec S, Kokol P: Intelligent analysis in predicting outcome of out-of-hospital cardiac arrest. Comput Methods Programs Biomed 2009, 95: S22-S32. 10.1016/j.cmpb.2009.02.013PubMedCrossRef

Berek K, Schinnerl A, Traweger C, Lechleitner P, Baubin M, Aichner F: The prognostic significance of coma-rating, duration of anoxia and cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Neurol 1997, 244: 556-561. 10.1007/s004150050143PubMedCrossRef

10.

Vivien B, Amour J, Nicolas-Robin A, Vesque M, Langeron O, Coriat P, Riou B: An evaluation of capnography monitoring during the apnoea test in brain-dead patients. Eur J Anaesthesiol 2007, 24: 868-875. 10.1017/S0265021507000725PubMedCrossRef

11.

Fries M, Weil MH, Chang YT, Castillo C, Tang W: Microcirculation during cardiac arrest and resuscitation. Crit Care Med 2006, 34: S454-S457. 10.1097/01.CCM.0000247717.81480.B2PubMedCrossRef

12.

Grmec Š, Lah K, Tušek Bunc K: Difference in end-tidal CO2 between asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting. Crit Care 2003, 7: R139-R144. 10.1186/cc2369PubMedPubMedCentralCrossRef

13.

Grmec S, Strnad M, Podgorsek D: Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med 2009, 2: 7-12. 10.1007/s12245-009-0084-0PubMedPubMedCentralCrossRef

14.

Vaagenes P, Safar P, Moossy J, Rao G, Diven W, Ravi C, Arfors K: Asphyxiation versus ventricular fibrillation cardiac arrest in dogs. Differences in cerebral resuscitation effects--a preliminary study. Resuscitation 1997, 35: 41-52. 10.1016/S0300-9572(97)01108-8PubMedCrossRef

15.

Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ: Does hypoxia or hypercarbia independently affect resuscitation from cardiac arrest? Chest 1995, 108: 522-528. 10.1378/chest.108.2.522PubMedCrossRef

16.

Kamohara T, Weil MH, Tang W, Sun S, Yamaguchi H, Klouche K, Bisera J: A comparison of myocardial function after primary cardiac and primary asphyxial cardiac arrest. Am J Respir Crit Care Med 2001, 164: 1221-1224.PubMedCrossRef

17.

Mithoefer JC, Mead G, Hughes JM, Iliff LD, Campbell EJ: A method of distinguishing death due to cardiac arrest from asphyxia. Lancet 1967, 2: 654-656. 10.1016/S0140-6736(67)90691-5PubMedCrossRef

18.

International Liasion Committee on Resuscitation: 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2005, 67: 181-314. 10.1016/j.resuscitation.2005.05.011CrossRef

19.

ECC Committee, Subcommittees and Task Forces of the American Heart Association: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005, 112: IV1-IV203.CrossRef

20.

European Resuscitation Council: European Resuscitation Council Guidelines for Resuscitation 2005. Resuscitation 2005, 67: 181-341. 10.1016/j.resuscitation.2005.09.010CrossRef

21.

Hallstrom A, Rea TD, Mosesso VN Jr, Cobb LA, Anton AR, Van Ottingham L, Sayre MR, Christenson J: The relationship between shocks and survival in out-of-hospital cardiac arrest patients initially found in PEA or asystole. Resuscitation 2007, 74: 418-426. 10.1016/j.resuscitation.2007.02.003PubMedCrossRef

22.

Hallstrom A, Herlitz J, Kajino K, Olasveengen TM: Treatment of asystole and PEA. Resuscitation 2009, 80: 975-976. 10.1016/j.resuscitation.2009.05.019PubMedCrossRef

23.

Geddes LA, Roeder RA, Rundell AE, Otlewski MP, Kemeny AE, Lottes AE: The natural biochemical changes during ventricular fibrillation with cardiopulmonary resuscitation and the onset of postdefibrillation pulseless electrical activity. Am J Emerg Med 2006, 24: 577-581. 10.1016/j.ajem.2006.01.030PubMedCrossRef

24.

Campbell RL, Hess EP, Atkinson EJ, White RD: Assessment of a three-phase model of out-of-hospital cardiac arrest in patients with ventricular fibrillation. Resuscitation 2007, 73: 229-235. 10.1016/j.resuscitation.2006.08.031PubMedCrossRef

25.

Rittenberger JC, Menegazzi JJ, Callaway CW: Association of delay to first intervention with return of spontaneous circulation in a swine model of cardiac arrest. Resuscitation 2007, 73: 154-160. 10.1016/j.resuscitation.2006.07.029PubMedCrossRef

26.

Baker PW, Conway J, Cotton C, Ashby DT, Smyth J, Woodman RJ, Grantham H: Clinical investigators. Defibrillation or cardiopulmonary resuscitation first for patients with out-of-hospital cardiac arrests found by paramedics to be in ventricular fibrillation? A randomized control trial. Resuscitation 2008, 79: 424-423. 10.1016/j.resuscitation.2008.07.017PubMedCrossRef

27.

DeBehnke DJ, Hilander SJ, Dobler DW, Wickman LL, Swart GL: The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 1995, 30: 169-175. 10.1016/0300-9572(95)00873-RPubMedCrossRef

28.

Hendrickx HH, Safar P, Miller A: Asphyxia, cardiac arrest and resuscitation in rats. II. Long term behavioral changes. Resuscitation 1984, 12: 117-128. 10.1016/0300-9572(84)90063-7PubMedCrossRef

29.

Noc M, Weil MH, Tang W, Turner T, Fukui M: Mechanical ventilation may not be essential for initial cardiopulmonary resuscitation. Chest 1995, 108: 821-827. 10.1378/chest.108.3.821PubMedCrossRef

30.

Herff H, Bowden K, Paal P, Mitterlechner T, von Goedecke A, Lindner KH, Wenzel V: Effect of decreased inspiratory times on tidal volume. Bench model simulating cardiopulmonary resuscitation. Anaesthesist 2009, 58: 686-690. 10.1007/s00101-009-1564-6PubMedCrossRef

31.

Yeh ST, Cawley RJ, Aune SE, Angelos MG: Oxygen requirement during cardiopulmonary resuscitation (CPR) to effect return of spontaneous circulation. Resuscitation 2009, 80: 951-955. 10.1016/j.resuscitation.2009.05.001PubMedCrossRef

32.

Linner R, Werner O, Perez-de-Sa V, Cunha-Goncalves D: Circulatory recovery is as fast with air ventilation as with 100% oxygen after asphyxia-induced cardiac arrest in piglets. Pediatr Res 2009, 66: 391-394. 10.1203/PDR.0b013e3181b3b110PubMedCrossRef

33.

Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ: Does hypoxia or hypercapnia independently affect resuscitation from cardiac arrest? Chest 1995, 108: 522-528. 10.1378/chest.108.2.522PubMedCrossRef

Title: The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest
Authors: Katja Lah
Miljenko Križmarić
Štefek Grmec
Publication date: 01-02-2011
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2011
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9417

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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