End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation

RESUSCITATION

卷:133

Article

Berg, Robert A.¹  Reeder, Ron W.²  Meert, Kathleen L.³  Yates, Andrew R.⁴  Berger, John T.⁵  Newth, Christopher J.⁶  Carcillo, Joseph A.⁷  McQuillen, Patrick S.⁸  Harrison, Rick E.⁹  Moler, Frank W.¹⁰  Pollack, Murray M.^5,11  Carpenter, Todd C.¹²  Notterman, Daniel A.¹³  Holubkov, Richard²  Dean, J. Michael²  Nadkarni, Vinay M.¹  Sutton, Robert M.¹ 

[1] Univ Penn, Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, 3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA

[2] Univ Utah, Dept Pediat, 295 Chipeta Way, Salt Lake City, UT 84158 USA

[3] Wayne State Univ, Childrens Hosp Michigan, Dept Pediat, 3901 Beaubien Blvd, Detroit, MI 48201 USA

[4] Ohio State Univ, Nationwide Childrens Hosp, Dept Pediat, 611 East Livingston Ave, Columbus, OH 43205 USA

[5] Childrens Natl Med Ctr, Dept Pediat, 111 Michigan Ave NW, Washington, DC 20010 USA

[6] Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Dept Anesthesiol, 1975 Zonal Ave, Los Angeles, CA 90033 USA

[7] Univ Pittsburgh, Childrens Hosp Pittsburgh, Dept Crit Care Med, 4401 Penn Ave, Pittsburgh, PA 15224 USA

[8] Univ Calif San Francisco, Benioff Childrens Hosp, Dept Pediat, 1550 4th St, San Francisco, CA 94158 USA

[9] Univ Calif Los Angeles, Mattel Childrens Hosp, Dept Pediat, 757 Westwood Plaza, Los Angeles, CA 90095 USA

[10] Univ Michigan, Dept Pediat, CS Mott Childrens Hosp, 1540 E Hosp Dr, Ann Arbor, MI 48109 USA

[11] Phoenix Childrens Hosp, Dept Pediat, 1919 E Thomas Rd, Phoenix, AZ 85016 USA

[12] Univ Colorado, Childrens Hosp Colorado, Dept Pediat, 13121 East 17th Ave, Denver, CO 80045 USA

[13] Princeton Univ, Dept Mol Biol, Lewis Thomas Lab 219, Princeton, NJ 08544 USA

关键词: Cardiopulmonary resuscitation (CPR);    Cardiac arrest;    End-tidal carbon dioxide (ETCO2);    Pediatric;    In-hospital;    Survival;   

DOI  :  10.1016/j.resuscitation.2018.08.013

来源: Elsevier

【 摘 要 】

Background: Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) > 20 mmHg. Aims: We prospectively evaluated whether ETCO2 > 20 mmHg during CPR was associated with survival to hospital discharge. Methods: Children >= 37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for >= 1 min and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. ETCO2 and Utstein-style cardiac arrest data were collected. Multivariable Poisson regression models with robust error estimates were used to estimate relative risk of outcomes. Results: Blinded investigators analyzed ETCO2 waveforms from 43 children. During CPR, the median ETCO2 was 23 mmHg [quartiles, 16 and 28 mmHg], median ventilation rate was 29 breaths/min [quartiles, 24 and 35 breaths/ min], and median duration of CPR was 5 min [quartiles, 2 and 16 min]. Return of spontaneous circulation occurred after 71% of CPR events and 37% of patients survived to hospital discharge. For children with mean ETCO2 during CPR > 20 mmHg, the adjusted relative risk for survival was 0.92 (0.41, 2.08), p = 0.84. The median mean ETCO2 among children who survived to hospital discharge was 20 mmHg [quartiles; 15, 28 mmHg] versus 23 mmHg [16, 28 mmHg] among non-survivors. Conclusion: Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with survival to hospital discharge, and ETCO2 was not different in survivors versus non-survivors.

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