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Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation
BACKGROUND: Measurement of end-tidal CO(2) (ETCO(2)) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigat...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130954/ https://www.ncbi.nlm.nih.gov/pubmed/34003839 http://dx.doi.org/10.1371/journal.pone.0251511 |
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author | Gutiérrez, Jose Julio Leturiondo, Mikel Ruiz de Gauna, Sofía Ruiz, Jesus María Azcarate, Izaskun González-Otero, Digna María Urtusagasti, Juan Francisco Russell, James Knox Daya, Mohamud Ramzan |
author_facet | Gutiérrez, Jose Julio Leturiondo, Mikel Ruiz de Gauna, Sofía Ruiz, Jesus María Azcarate, Izaskun González-Otero, Digna María Urtusagasti, Juan Francisco Russell, James Knox Daya, Mohamud Ramzan |
author_sort | Gutiérrez, Jose Julio |
collection | PubMed |
description | BACKGROUND: Measurement of end-tidal CO(2) (ETCO(2)) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO(2) variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO(2) during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. METHODS: We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO(2) between consecutive ventilations was computed and its average value, ΔET(avg), was used as a single feature to discriminate between ROSC and non-ROSC segments. RESULTS: A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔET(avg) was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. CONCLUSION: Average percent variation of ETCO(2) during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings. |
format | Online Article Text |
id | pubmed-8130954 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-81309542021-05-27 Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation Gutiérrez, Jose Julio Leturiondo, Mikel Ruiz de Gauna, Sofía Ruiz, Jesus María Azcarate, Izaskun González-Otero, Digna María Urtusagasti, Juan Francisco Russell, James Knox Daya, Mohamud Ramzan PLoS One Research Article BACKGROUND: Measurement of end-tidal CO(2) (ETCO(2)) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO(2) variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO(2) during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. METHODS: We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO(2) between consecutive ventilations was computed and its average value, ΔET(avg), was used as a single feature to discriminate between ROSC and non-ROSC segments. RESULTS: A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔET(avg) was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. CONCLUSION: Average percent variation of ETCO(2) during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings. Public Library of Science 2021-05-18 /pmc/articles/PMC8130954/ /pubmed/34003839 http://dx.doi.org/10.1371/journal.pone.0251511 Text en © 2021 Gutiérrez et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Gutiérrez, Jose Julio Leturiondo, Mikel Ruiz de Gauna, Sofía Ruiz, Jesus María Azcarate, Izaskun González-Otero, Digna María Urtusagasti, Juan Francisco Russell, James Knox Daya, Mohamud Ramzan Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title | Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title_full | Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title_fullStr | Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title_full_unstemmed | Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title_short | Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
title_sort | assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130954/ https://www.ncbi.nlm.nih.gov/pubmed/34003839 http://dx.doi.org/10.1371/journal.pone.0251511 |
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