Focused echocardiography, end-tidal carbon dioxide, arterial blood pressure or near-infrared spectroscopy monitoring during paediatric cardiopulmonary resuscitation: A scoping review

Abstract

Aim: To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO₂), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children.

Methods: This scoping review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews. PubMed, MEDLINE, CINAHL and EMBASE were searched from the last ILCOR reviews until September 2020. We included all published studies evaluating the effect of echocardiography, EtCO₂, BP or NIRS guided CPR on clinical outcomes and quality of CPR.

Results: We identified eight observational studies, including 288 children. Two case series reported the use of echocardiography, one in detecting pulmonary emboli, the second in cardiac standstill, where contractility was regained with the use of extracorporeal membrane oxygenation. The two studies describing EtCO₂ were ambivalent regarding the association between mean values and any outcomes. Mean diastolic BP was associated with increased survival and favourable neurological outcome, but not with new substantive morbidity in two studies describing an overlapping population. NIRS values reflected changes in EtCO₂ and cerebral blood volume index in two studies, with lower values in patients who did not achieve return of circulation.

Conclusion: Although there seems some beneficial effect of these intra-arrest variables, higher quality paediatric studies are needed to evaluate whether echocardiography, EtCO₂, BP or NIRS guided CPR could improve outcomes.

Keywords: Arterial blood pressure; BP, blood pressure (invasive arterial); BVI, blood volume index; CA, cardiac arrest; CI, confidence interval; CPR, cardiopulmonary resuscitation; CSF, cerebrospinal fluid; Cardiopulmonary resuscitation; CoSTR, consensus on science with treatment recommendations; ECG, electrocardiogram; ECMO, extracorporeal membrane oxygenation; ECPR, extracorporeal cardiopulmonary resuscitation; ED, emergency department; End-tidal CO2; EtCO2, end-tidal carbon dioxide; ICP, intracranial pressure; IHCA, in-hospital cardiac arrest; ILCOR, international liaison committee on resuscitation; NICU, neonatal intensive care unit; NIRS, near-infrared spectroscopy; Near-infrared spectroscopy; OHCA, out-of-hospital cardiac arrest; OR, odds ratio; PCICU, paediatric cardiac intensive care unit; PE, pulmonary emboli; PICU, paediatric intensive care unit; PRISMA, preferred reporting items for systematic reviews and meta-analyses; Paediatric life support; Point-of-care ultrasound; RCT, randomized controlled trial; ROC, receiver operating characteristic; ROSC, return of spontaneous circulation; RR, relative risk; RV, right ventricle; SD, standard deviation; USA, United States of America; rcSO2, regional cerebral oxygen saturations.

Fig. 1

PRISMA diagram of echocardiography, EtCO_2, BP and NIRS during paediatric cardiac arrest. EtCO₂ = End-tidal carbon dioxide, BP = Blood pressure, NIRS = Near-infrared spectroscopy.