Abstract
Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO2 (ETCO2) monitoring may provide a continuous noninvasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO2 value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO2 that is associated with ROSC after asphyxia-induced asystole. Neonatal swine (n = 46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O2 followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 s, and ETCO2 was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO2 values, where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO2 cut-off value of 14 mm Hg is the most sensitive ETCO2 value with the least false positives. When using ETCO2 to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO2 ≥14 mm Hg is achieved. Correlation during human neonatal CPR needs further investigation.
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Abbreviations
- CPR:
-
cardiopulmonary resuscitation
- d :
-
distance
- ETCO2:
-
end-tidal CO2
- HR:
-
heart rate
- NRP:
-
Neonatal Resuscitation Program
- PPV:
-
positive pressure ventilation
- ROC:
-
receiver operator characteristic
- ROSC:
-
return of spontaneous circulation
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This work was supported by an American Academy of Pediatrics Neonatal Resuscitation Program Research Grant. In addition, L.F.C. and L.H. are supported by grant KL2RR024983, titled, “North and Central Texas Clinical and Translational Science Initiative” from the National Center for Research Resources (NCRR, NIH).
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Chalak, L., Barber, C., Hynan, L. et al. End-Tidal CO2 Detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resuscitation After Asystole in Asphyxiated Piglets. Pediatr Res 69, 401–405 (2011). https://doi.org/10.1203/PDR.0b013e3182125f7f
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DOI: https://doi.org/10.1203/PDR.0b013e3182125f7f
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