Document Detail

End-tidal CO₂ detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets.
MedLine Citation:
PMID:  21283051     Owner:  NLM     Status:  MEDLINE    
Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO₂ (ETCO₂) monitoring may provide a continuous noninvasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO₂ value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO₂ that is associated with ROSC after asphyxia-induced asystole. Neonatal swine (n = 46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O₂ followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 s, and ETCO₂ was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO₂ values, where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO₂ cut-off value of 14 mm Hg is the most sensitive ETCO₂ value with the least false positives. When using ETCO₂ to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO₂ ≥ 14 mm Hg is achieved. Correlation during human neonatal CPR needs further investigation.
Lina F Chalak; Chad A Barber; Linda Hynan; Damian Garcia; Lucy Christie; Myra H Wyckoff
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric research     Volume:  69     ISSN:  1530-0447     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-15     Completed Date:  2011-07-25     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  401-5     Citation Subset:  IM    
Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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MeSH Terms
Adrenergic Agonists / administration & dosage
Animals, Newborn
Asphyxia Neonatorum / complications*,  metabolism,  physiopathology
Biological Markers / metabolism
Blood Pressure
Breath Tests*
Carbon Dioxide / metabolism*
Cardiopulmonary Resuscitation* / methods
Disease Models, Animal
Epinephrine / administration & dosage
Heart Arrest / etiology,  metabolism,  physiopathology,  therapy*
Heart Auscultation
Heart Massage
Heart Rate*
Infant, Newborn
Positive-Pressure Respiration
Predictive Value of Tests
Sus scrofa
Time Factors
Grant Support
Reg. No./Substance:
0/Adrenergic Agonists; 0/Biological Markers; 124-38-9/Carbon Dioxide; 51-43-4/Epinephrine

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