Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest

doi:10.5847/wjem.j.issn.1920-8642.2014.02.007

Abstract

Abstract:

BACKGROUND: Partial pressure of end-tidal carbon dioxide (P_ETCO₂) has been used to monitor the effectiveness of precordial compression (PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation (CPR). This study was to investigate changes of P_ETCO₂ during CPR in rats with ventricular fibrillation (VF) versus asphyxial cardiac arrest.
METHODS: Sixty-two male Sprague-Dawley (SD) rats were randomly divided into an asphyxial group (n=32) and a VF group (n=30). P_ETCO₂ was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest.
RESULTS: The initial values of P_ETCO₂ immediately after PC in the VF group were significantly lower than those in the asphyxial group (12.8±4.87 mmHg vs. 49.2±8.13 mmHg, P=0.000). In the VF group, the values of P_ETCO₂ after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation (ROSC), compared with those in rats without ROSC (16.5±3.07 mmHg vs. 13.2±2.62 mmHg, P=0.004). In the asphyxial group, the values of P_ETCO₂ after 2 minutes of PC in rats with ROSC were significantly higher than those in rats without ROSC (20.8±3.24 mmHg vs. 13.9±1.50 mmHg, P=0.000). Receiver operator characteristic (ROC) curves of P_ETCO₂ showed significant sensitivity and specificity for predicting ROSC in VF versus asphyxial cardiac arrest.
CONCLUSIONS: The initial values of P_ETCO₂ immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of P_ETCO₂ during CPR can predict outcomes of CPR.

Key words: Partial pressure of end-tidal carbon dioxide, Cardiac arrest, Cardiopulmonary resuscitation, Return of spontaneous circulation, Rats

Qing-ming Lin, Xiang-shao Fang, Li-li Zhou, Yue Fu, Jun Zhu, Zi-tong Huang. Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest[J]. World Journal of Emergency Medicine, 2014, 5(2): 116-121.

Figures/Tables 6

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References 24

1	Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S640-56. doi: 10.1161/CIRCULATIONAHA.110.970889 pmid: 20956217
2	Pokorná M, Necas E, Kratochvíl J, Skripský R, Andrlík M, Franek O. A sudden increase in partial pressure end-tidal carbon dioxide (P_ETCO₂) at the moment of return of spontaneous circulation. J Emerg Med 2010; 38:614-621. doi: 10.1016/j.jemermed.2009.04.064 pmid: 19570645
3	Sehra R, Underwood K, Checchia P. End tidal CO₂ is a quantitative measure of cardiac arrest. Pacing.Clin Electrophysiol 2003; 26(1 Pt 2):515-517.
4	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. doi: 10.1186/cc7009 pmid: 18786260
5	Weil MH. Partial pressure of end-tidal carbon dioxide predicts successful cardiopulmonary resuscitation in the field. Crit Care 2008; 12:90. doi: 10.1186/cc7090 pmid: 19014673
6	Lah K, Križmarić M, Grmec S. The dynamic pattern of end-tidal carbon dioxide during cardiopulmonary resuscitation: difference between asphyxial cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. Crit Care 2011; 15:R13. pmid: 21223550
7	Grmec S, Lah K, Tusek-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:R139-144. doi: 10.1186/cc2369 pmid: 14624688
8	Berg RA, Henry C, Otto CW, Sanders AB, Kern KB, Hilwig RW, et al. Initial end-tidal CO₂ is markedly elevated during cardiopulmonary resuscitation after asphyxial cardiac arrest. Pediatr Emerg Care 1996; 12:245-248. doi: 10.1097/00006565-199608000-00002 pmid: 8858644
9	Luo XR, Zhang HL, Chen GJ, Ding WS, Huang L. Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis. World J Emerg Med 2013; 4:266-272. pmid: 25215130
10	Trevino RP, Bisera J, Weil MH, Rackow EC, Grundler WG. End-tidal CO₂ as a guide to successful cardiopulmonary resuscitation: a preliminary report. Crit Care Med 1985; 13:910-911. doi: 10.1097/00003246-198511000-00012 pmid: 3931980
11	Von Planta M, von Planta I, Weil MH, Bruno S, Bisera J, Rackow EC. End tidal carbon dioxide as an haemodynamic determinant of cardiopulmonary resuscitation in the rat. Cardiovasc Res 1989; 23:364-368. doi: 10.1093/cvr/23.4.364 pmid: 2512010
12	Kern KB, Sanders AB, Voorhees WD, Babbs CF, Tacker WA, Ewy GA. Changes in expired end-tidal carbon dioxide during cardiopulmonary resuscitation in dogs: a prognostic guide for resuscitation efforts. J Am Coll Cardiol 1989; 13:1184-1189. doi: 10.1016/0735-1097(89)90282-9 pmid: 2494245
13	Morimoto Y, Kemmotsu O, Murakami F, Yamamura T, Mayumi T. End-tidal CO₂ changes under constant cardiac output during cardiopulmonary resuscitation. Crit Care Med 1993; 21:1572-1576. doi: 10.1097/00003246-199310000-00028 pmid: 8403969
14	Fang X, Tang W, Sun S, Huang L, Huang Z, Weil MH. Mechanism by which activation of delta-opioid receptor reduces the severity of postresuscitation myocardial dysfunction. Crit Care Med 2006; 34:2607-2612.
15	Sanders AB, Kern KB, Berg RA. Searching for a predictive rule for terminating cardiopulmonary resuscitation. Acad Emerg Med 2001; 8:654-657. doi: 10.1111/j.1553-2712.2001.tb00180.x pmid: 11388942
16	Fries M, Weil MH, Chang YT, Castillo C, Tang W. Microcirculation during cardiac arrest and resuscitation. Crit Care Med 2006; 34:S454-457. doi: 10.1097/01.CCM.0000247717.81480.B2 pmid: 17114977
17	Higgins D, Hayes M, Denman W, Wilkinson DJ. Effectiveness of using end tidal carbon dioxide concentration to monitor cardiopulmonary resuscitation. BMJ 1990; 300:581. doi: 10.1136/bmj.300.6724.581 pmid: 2108755
18	Morimoto Y, Kemmotsu O, Morimoto Y, Gando S. End-tidal carbon dioxide and resuscitation. Curr Opin Anaesthesiol 1999; 12:173-177. doi: 10.1097/00001503-199904000-00011 pmid: 17013310
19	Wu JY, Li CS, Liu ZX, Wu CJ, Zhang GC. A comparison of 2 types of chest compressions in a porcine model of cardiac arrest. Am J Emerg Med 2009; 27:823-829. pmid: 19683111
20	Morley PT. Improved cardiac arrest outcomes: as time goes by? Crit Care 2007; 11:130. doi: 10.1186/cc5784 pmid: 17498319
21	Shibutani K, Muraoka M, Shirasaki S, Kubal K, Sanchala VT, Gupte P. Do changes in end-tidal PCO₂ quantitatively reflect changes in cardiac output? Anesth Analg 1994; 79:829-833. doi: 10.1213/00000539-199411000-00002 pmid: 7978395
22	White RD, Goodman BW, Svoboda MA. Neurologic recovery following prolonged out-of-hospital cardiac arrest with resuscitation guided by continuous capnography. Mayo Clin Proc 2011; 86:544-548. doi: 10.4065/mcp.2011.0229 pmid: 21508320
23	Gudipati CV, Weil MH, Bisera J, Deshmukh HG, Urban G, Rackow EC, et al. Mean aortic pressure: a monitor of successful CPR. Chest 1986; 89:446S.
24	Sanders AB, Atlas M, Ewy GA, Kern KB, Bragg S. Expired CO₂ as an index of coronary perfusion pressure. Am J Emerg Med 1985; 3:147-149. doi: 10.1016/0735-6757(85)90039-7 pmid: 3918548

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