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End-tidal CO2 concentration during prehospital CPR: A predictor of successful resuscitation?
190
PO37 END-TIDAL CO2 CONCENTRATION DURING PREHOSPITAL A PREDICTOR OF SUCCESSFUL RESUSCITATION Y. Lamkn.
MD., J.P. Candnea”. M.D., P. Merck
CPR
:
7
M.D.. P. Duvaldesdn. M.D.
SAM” 94.Aries. Dept., CHU Henri Mondor, 94010. Creteil. France
cardiac
The besr scnsitwity, specificity. pasmve and rncgative pred!ctwe val”es were “brained wilh MAX > 30 mmHg (Table II). Tab. ,I I SenWiWy ) Speciflclty PPV NP” IN, > 15 cc max > 2 0.5 I .oo 1MAX >3” I .oo i m:i As previously descrhed, wccessfid re~uscitador IS associated with B marked rise in ETCO2. Neverrhelesr. thls rise is 10” close to rct”m of spomaneous pulse and canno, be considered as a predictive indicator. 11,rhls arudy. earlier peak ETCO] > 20 mmHg IP as sensinve in detecdng patients who will be nuccessfillly rcsuxnsted. CPR OUTCOME
PO39
PREHOSPITAL
CARDIAC ARREST
P. Merck
M.D., J.P. Cantineau
SAMU 94-Aries.
End&da1 CO2 (ETCO2) mcasuremnr 1s a valuable noninvr&e led for assessing outpvr during CPR. Its utility as a predictor of successful resuscitadon remains connoversial .The aim of this pmrpecuve study was to compare ETCOZ vs,“es with resuscitation ~“fcome in prehospital rctting. &t&&: After insdrutional approval, 17 parieno >I8 yr of age m nantraumadc prehospital cardiac arrest were studied. Rerusciudon WE mitiated by firefighters (BCLS) accordmg to AHA guidelines. Then advanced CPR was provided by the prehospilal medical team includmg one anesthesiologist. As xx)” as trachea was inmbned, mechanical vcndladon was applied L c~nsfant mtc and flow. and ETCO2 was continuously measured (Nomxcap 200, Dasx, Finland). Successful resuscitadon (R+) was defined “s ret”m of a self-sustaind blmd prcssurc for at least 1 hour. ETCO2 w,“cs for each patient were cxegorired as initial (value “brained ahcr 1 min of mechanical ventiladon: INI). minimum (MIN). nuximum during cardiac arrest (highest value &tamed during chest comprcraions: CCmnx). and mxdmum during the whole rewrciradon period (highest value obtnmed. including eventual successful resuscitation: MAX). Values are expressed as mea” f SD. The IWOgroups (Rc and R-1 rue compand “sing the Student’s, ,a, for unpaired samples. w: Four padents were successfully resusxared. Initial cardnc rhythm was VF in IWO nonresuscitated patients, and asysmlc in a11other p;we~m. There is no dlfferencc between the two groups for age and dundon of resusandon. For each category excepr for MIN. ETC02 values wcrc higher in group R+ than I” group R- (Table I).
1 ) ( I.OlI I 053 , 0.40 I 1.00
EFFECT OF EPINEPHWNE ON END-TIDAL CARBON DIOXK,E “ju.,ES DURING PREHOSPmAL. CARDIOPULMONARY RES”SCITAT,ON
End-tidal
M.D.. Y Lambert
Dept. CH” Hen,,
CO,
IETCO,)
Mondor.
measurement
M.D.. P. Duvaldestin
M.D.
94010 CrCteil. FRANCE Is a valuable
nonlnvasLve
tcol
lor
assessing cardtic &tput during CardiopuLmonmy resuscitation (CPRI. and could be used as a predictor of successful resuscitation. Epinepbrlne Lmproves coronary perfusion pressure. but its effects on ETCO, are controversial. The aim of tbls prospective study was to quantiy changes in ETCOa induced by epinepbrine (El during CPR h prehospltal setting. After tnstltutlonal approval. 16 pauents (age range: 37-W years, I” Methods “cmtra”mat,c Cardiac arrest were studied. lnltlal cardiac rhythm was ventricular asystole in a,, patients on arrtval of the prehospital medical team. lncludlng one anesthesiologist. As soon as trachea was Intubated. E (5 mg) was adminlstered through the tube. Mechanical vent”aUon was achieved at constant rate and flow. and ETCO, was continuously recorded (Normccap 200. Datex. Finland). Flw minutes followlng tracheal intubatnn. E ,2 mg, was injected intravenously. ETCO, values before and 3 minutes after E i”,eetlon were compared using the Student’s t teat for palred data. Results are expressed as mean + SD. Four patients exhibited retun of spontaneous pulse during CPR. but g&&i Ln all cases after the studied period. E iv l”,ection resulted in a slgnincant decrease Ln ETCO, from 10.3 mmHg + 7.2 to 8.5 mmHg + 5.2 (pcO.011. This decrease was only observed In 7 patients [group At,. wlthout any change for the remlnlng 9 patients (g~up A-l. he-InjeCtIOn ETCO, value WAS Slgnlfkandy (pCo.ooL) higher m group A+ (16 7 mmHg + 6.5) than in group A- (5.3 mmHg + 1.3,. In group A+, the decrease in ETCO2 following E was 4. L mmHg + 1.2
Discuss,“ E”l”,ectio” during
CPR results
In a decrease
in ETCO,.
Th,s
effect
should be addressed when assessing CPR efficacy or predictmg outcome using this Hypotheses are a decrease m pulmonary blood flow. a decrease In CO, parameter. production. an increase In venous admixture. The epinephrme-lndurrd decrease I” ETCO, was not observed in all patients. Our results sug_ges, that the lack of decrease could reflect poor pulmonary blood “ow or CO, prcducbon during CPR.
CAPNOGRAPHY
PO40
PO37 END-TIDAL CO2 CONCENTRATION DURING PREHOSPITAL A PREDICTOR OF SUCCESSFUL RESUSCITATION Y. Lamkn.
MD., J.P. Candnea”. M.D., P. Merck
CPR
:
7
M.D.. P. Duvaldesdn. M.D.
SAM” 94.Aries. Dept., CHU Henri Mondor, 94010. Creteil. France
cardiac
The besr scnsitwity, specificity. pasmve and rncgative pred!ctwe val”es were “brained wilh MAX > 30 mmHg (Table II). Tab. ,I I SenWiWy ) Speciflclty PPV NP” IN, > 15 cc max > 2 0.5 I .oo 1MAX >3” I .oo i m:i As previously descrhed, wccessfid re~uscitador IS associated with B marked rise in ETCO2. Neverrhelesr. thls rise is 10” close to rct”m of spomaneous pulse and canno, be considered as a predictive indicator. 11,rhls arudy. earlier peak ETCO] > 20 mmHg IP as sensinve in detecdng patients who will be nuccessfillly rcsuxnsted. CPR OUTCOME
PO39
PREHOSPITAL
CARDIAC ARREST
P. Merck
M.D., J.P. Cantineau
SAMU 94-Aries.
End&da1 CO2 (ETCO2) mcasuremnr 1s a valuable noninvr&e led for assessing outpvr during CPR. Its utility as a predictor of successful resuscitadon remains connoversial .The aim of this pmrpecuve study was to compare ETCOZ vs,“es with resuscitation ~“fcome in prehospital rctting. &t&&: After insdrutional approval, 17 parieno >I8 yr of age m nantraumadc prehospital cardiac arrest were studied. Rerusciudon WE mitiated by firefighters (BCLS) accordmg to AHA guidelines. Then advanced CPR was provided by the prehospilal medical team includmg one anesthesiologist. As xx)” as trachea was inmbned, mechanical vcndladon was applied L c~nsfant mtc and flow. and ETCO2 was continuously measured (Nomxcap 200, Dasx, Finland). Successful resuscitadon (R+) was defined “s ret”m of a self-sustaind blmd prcssurc for at least 1 hour. ETCO2 w,“cs for each patient were cxegorired as initial (value “brained ahcr 1 min of mechanical ventiladon: INI). minimum (MIN). nuximum during cardiac arrest (highest value &tamed during chest comprcraions: CCmnx). and mxdmum during the whole rewrciradon period (highest value obtnmed. including eventual successful resuscitation: MAX). Values are expressed as mea” f SD. The IWOgroups (Rc and R-1 rue compand “sing the Student’s, ,a, for unpaired samples. w: Four padents were successfully resusxared. Initial cardnc rhythm was VF in IWO nonresuscitated patients, and asysmlc in a11other p;we~m. There is no dlfferencc between the two groups for age and dundon of resusandon. For each category excepr for MIN. ETC02 values wcrc higher in group R+ than I” group R- (Table I).
1 ) ( I.OlI I 053 , 0.40 I 1.00
EFFECT OF EPINEPHWNE ON END-TIDAL CARBON DIOXK,E “ju.,ES DURING PREHOSPmAL. CARDIOPULMONARY RES”SCITAT,ON
End-tidal
M.D.. Y Lambert
Dept. CH” Hen,,
CO,
IETCO,)
Mondor.
measurement
M.D.. P. Duvaldestin
M.D.
94010 CrCteil. FRANCE Is a valuable
nonlnvasLve
tcol
lor
assessing cardtic &tput during CardiopuLmonmy resuscitation (CPRI. and could be used as a predictor of successful resuscitation. Epinepbrlne Lmproves coronary perfusion pressure. but its effects on ETCO, are controversial. The aim of tbls prospective study was to quantiy changes in ETCOa induced by epinepbrine (El during CPR h prehospltal setting. After tnstltutlonal approval. 16 pauents (age range: 37-W years, I” Methods “cmtra”mat,c Cardiac arrest were studied. lnltlal cardiac rhythm was ventricular asystole in a,, patients on arrtval of the prehospital medical team. lncludlng one anesthesiologist. As soon as trachea was Intubated. E (5 mg) was adminlstered through the tube. Mechanical vent”aUon was achieved at constant rate and flow. and ETCO, was continuously recorded (Normccap 200. Datex. Finland). Flw minutes followlng tracheal intubatnn. E ,2 mg, was injected intravenously. ETCO, values before and 3 minutes after E i”,eetlon were compared using the Student’s t teat for palred data. Results are expressed as mean + SD. Four patients exhibited retun of spontaneous pulse during CPR. but g&&i Ln all cases after the studied period. E iv l”,ection resulted in a slgnincant decrease Ln ETCO, from 10.3 mmHg + 7.2 to 8.5 mmHg + 5.2 (pcO.011. This decrease was only observed In 7 patients [group At,. wlthout any change for the remlnlng 9 patients (g~up A-l. he-InjeCtIOn ETCO, value WAS Slgnlfkandy (pCo.ooL) higher m group A+ (16 7 mmHg + 6.5) than in group A- (5.3 mmHg + 1.3,. In group A+, the decrease in ETCO2 following E was 4. L mmHg + 1.2
Discuss,“ E”l”,ectio” during
CPR results
In a decrease
in ETCO,.
Th,s
effect
should be addressed when assessing CPR efficacy or predictmg outcome using this Hypotheses are a decrease m pulmonary blood flow. a decrease In CO, parameter. production. an increase In venous admixture. The epinephrme-lndurrd decrease I” ETCO, was not observed in all patients. Our results sug_ges, that the lack of decrease could reflect poor pulmonary blood “ow or CO, prcducbon during CPR.
CAPNOGRAPHY
PO40