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. 2021 Mar;10(1):31-37.
doi: 10.1055/s-0040-1712531. Epub 2020 Jun 1.

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Awni M Al-Subu  1 , Timothy A Hacker  2 , Jens C Eickhoff  3 , George Ofori-Amanfo  4 , Marlowe W Eldridge  1
Affiliations

Volumetric Capnography Monitoring and Effects of Epinephrine on Volume of Carbon Dioxide Elimination during Resuscitation after Cardiac Arrest in a Swine Pediatric Ventricular Fibrillatory Arrest

Awni M Al-Subu et al. J Pediatr Intensive Care. 2021 Mar.

Abstract

The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO 2 ) and the volume of CO 2 elimination (VCO 2 ) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO 2 and VCO 2 had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 ( p < 0.001) and 0.53 ( p = 0.018), respectively. However, both EtCO 2 and VCO 2 had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 ( p = 0.484) (95% confidence interval [CI], -0.51-0.83) and 0.25 ( p = 0.566) (95% CI, -0.55-0.81), respectively. EtCO 2 and VCO 2 increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO 2 and VCO 2 and CO were weak 0.20 ( p = 0.646) (95% CI, -0.59-0.79), and 0.27 ( p = 0.543) (95% CI, -0.54-0.82) following epinephrine boluses. Continuous EtCO 2 and VCO 2 monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO 2 and VCO 2 to guide chest compression.

Keywords: VCO 2; end-tidal CO 2; monitoring; pediatric; resuscitation; volumetric capnography.

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Conflict of interest statement

Conflict of Interest M.W.E. received salary support for research from the U.S. Department of Defense, Navy (N00024–17-C-4318 and N0463A-12-C-0004). The remaining authors have disclosed that they do not have any potential conflict of interest.

Figures

Fig. 1
Fig. 1
Correlation between ( A ) end-tidal CO 2 (EtCO 2 ) and cardiac output (CO) goal, and ( B ) volume of CO 2 (VCO 2 ) and CO goal during cardiopulmonary resuscitation.
Fig. 2
Fig. 2
Receiver operation for the sudden increase in ( A ) end-tidal CO 2 and ( B ) volume of CO 2 to detect a return of spontaneous circulation. AUC: area under the curve.
See this image and copyright information in PMC

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