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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
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.
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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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