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Prehospital monitoring in resuscitation : today and the future


1Emergency Medical Center Maribor Medical Faculty, University of Maribor Medical Faculty, University of Ljubljana

DOI: 10.22514/SV51.092010.8 Vol.5,Issue S1,September 2010 pp.36-43

Published: 07 September 2010

*Corresponding Author(s): ŠTEFEK GRMEC E-mail:


There is growing evidence that early detection and response to physiological deterioration can improve outcome for patients. Working out-of-hospital, we often find ourselves in diagnostic dilemmas, thus more reliable data could change our actions as well as give better assessment of patient's condition. Therefore, we are always exploring new perspectives that could be transferred from experimental laboratory settings to our primary working area in the field to help us improve decision-making leading to better outcome. In the following sections, we represent our previous studies about the utility of continuous capnometry and the importance of point-of-care ultrasound in cardiopulmonary resuscitation (CPR), and dis-cuss about the possible future use of transthoracic and transesophageal ultrasound, point-of-care biochemical monitoring, tissue oxygen saturation, pupillometry, and mixed and central venous oxygen saturation monitoring in the prehospital setting.


cardiopulmonary resusci-tation, pre-hospital monitoring, cap-nometry, point-of care ultrasound and biochemical monitoring, pupil-lometry, mixed and central venous oxygen saturation, review

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ŠTEFEK GRMEC ,GREGOR PROSEN,BARBARA KIT,MATEJ STRNAD,PETRA KLEMEN. Prehospital monitoring in resuscitation : today and the future. Signa Vitae. 2010. 5(S1);36-43.


1. Dick FW. Anglo-American vs. Franco-German emergency medical services system. Prehosp Disaster Med 2003;18(1):29-35.

2. Grmec Š, Mally S. Emergency Medicine in Slovenia: Emergency Centre, Prehospital Emergency medicine and academic Emergency Medicine. Lije􀀂 Vjesn 2009;131(Supl 4):16-20.

3. Dickinson ET,Schneider RM,Verdile VP. The impact of prehospital physician on out-of-hospital nonasystolic cardiac arrest. Prehosp Emerg Care 1997; 1(3):132-5.

4. Benitez FL, Pepe PE. Role of the physcian in prehopsital management of trauma: North American Perspective. Curr Opin Crit Care 2002;8(6).551-8.

5. Moecke H,von Knobelsdorff G. The anesthesiologist in prehospital and hospital emergency medicine. Curr Opin Anaesthesiol 2008;21(2):228 -32.

6. Timmermann A, Russo SG,Hollmann MW. Paramedic versus emergency physician emergency medical service: role of the anaesthesiolo-gist and the Europena versus the Anglo-American concept. Curr Opin Anaesthesiol 2008;21(2):222-7.

7. Gazmuri RJ, Tandon M. Cardiopulmonry resuscitation:from flying blind to flying rigt. Crit Care Med 2008;36:357-9.

8. Ginsburg GS, Donahue MP, Newby LK. Prospects for personalized cardiovascular medicine:the impact of genomics. J Am Coll Cardiol 2005;46(9):1615-27

9. Synderman R, Yoediono Z. Perspective: Prospective health care and the role of academic medicine:lead,follow,or get out of the way. Acad Med 2008; 83(8):707-14

10. Auffray C,Chen Z, Hood L. Systems medicine:the future of medical genomics and healthcare. Genome Med 2009;1:2.

11. Meyers CM,Weingart SD.Critical care monitoring in emergency department. Emerg Med Practice 2007;9(7):2-27.

12. Grmec Š, Lah K. Clinical applications of capnometry/capnography and research in the Centre for emergency Medicine Maribor. Neurol Croat 2007;56(Suppl.4):59-68.

13. Grmec Š. Emergency endotracheal intubation:malposition and early detection. Int J Intensiv Care 2005;12(2):81-6.

14. Grmec Š. Comparison of three defferent methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med 2002; 28(6):701-4.

15. Grmec Š. Capnography - reliable technique for identifying correct tube placement in cardiac arrest endotracheal intubations. Resuscitation 2008;77(3):416-7.

16. Grmec S, Klemen P. Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest? Eur J Emerg Med 2001;8:263-9.

17. Grmec S, Kupnik D. Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting? Resuscitation 2003;58:89-96.

18. Grmec S, Lah K, Tušek Bunc K. Difference in end-tidal CO2 between asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting. Crit Care 2003;7:R139-R44.

19. Grmec Š, Križmari􀀁 M, Mally Š, Koželj A, Špindler M, Lešnik B. Utstein style analysis of out-of-hospital cardiac arrest-Bystander CPR and end expired carbon dioxide. Resuscitation 2007;72(3):404-14.

20. Kolar M, Križmari􀀁 M, Klemen P, Grmec Š. Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field - a prospective observational study.Crit Care.2008;12(5): R115 [1-13].

21. Križmari􀀁 M, Veli􀀂 M, Štiglic G, Grmec Š, Kokol P. Intelligent analysis in predicting outcome of out-of-hospital cardiac arrest. Comput Met-hods Programs Biomed 2009;95(Suppl.1):S22-S32.

22. Prosen G, Grmec Š, Kupnik D, Križmari􀀁 M, Završnik J, Gazmuri RJ. Focused echocardiography and capnography during resuscitation from pulseless electrical activity after out-of-hospital cardiac arrest. Crit Care 2009; 13(Suppl.1): S25-S6.

23. Prosen G, Križmari􀀁 M,Završnik J, Grmec Š. Does echocardiographically confirmed pseudo-PEA in out of hospital cardiac arrest patients with constant values of petCO2 during compression pauses indicate modified treatment? J Int Med Res 2010;38(in press).

24. Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: Cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation 2007;76:198-206.

25. Breitkreutz R, Walcher F, Seeger FH. Focused echocardiographic evaluation in resuscitation management: Concept of an advanced life support—conformed algorithm. Crit Care Med 2007;35:5

26. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am 2010;28:29-56.

27. Bazzocchi M, Quaia E, Zuiani C, Moroldo ML. Trans-cranial Doppler: state of the art. Eur J Radiol 1998;27:141–8.

28. Haas M, Allendorfer J, Walcher F, Neumann-Haefelin T, Blaivas M, Seeger FH, et al. Focused examination of cerebral blood flow in peri-resuscitation: a new advanced life support compliant concept—an extension of the focused echocardiography evaluation in life support examination. Crit Ultrasound J 2010;2:1-12.

29. Heidenreich P A. Transesophageal echocardiography (TEE) in the critical care patient. Cardiol Clin 2000;18(4):789-805.

30. Memtsoudis SG, Rosenberger P, Loffler M, Eltzschig HK, Mizuguchi A, Shernan SK, et al. The usefulness of transesophageal echocardi-ography during intraoperative cardiac arrest in noncardiac surgery. Anesth Analg 2006;102(6):1653-7.

31. Kozakova M, Palombo C, Pittella G, Distante A. Transesophageal echocardiography in myocardial ischemia: a review. Echocardiography 1995;12(5):479-94.

32. Krivec B, Voga G, Zuran I, Skale R, Pareznik R, Podbregar M, et al. Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transesophageal echocardiography and intrapulmonary trombolysis. Chest 1997;112(5):1310-6.

33. Saito Y, Donohue A, Attai S, Vahdat A, Brar R, Handapangoda I, et al. The syndrome of cardiac tamponade with »small« pericardial effusion. Echocardiography. 2008;25(3):321-7.

34. Kini V, Logani S, Ky B, Chirinos JA, Ferrari VA, St John Sutton MG, et al. Transthoracic and transesophageal echocardiography for the indication of suspescted infective endocarditis: vegetations, blood cultures and imaging. J Am Soc Echocardiography 2010;23(4):396-402.

35. Shiga T, Wajima Z, Apfel C C, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomograp-hy, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 2006;166(13):1350-6.

36. Vignon P. Hemodynamic assessment of critically ill patients using echocardiography Doppler. Curr Opin Crit Care 2005;11(3):227-34.

37. Anonymous. INVOS® System, 2007 (cited July 2010). Available:

38. Leal-Noval SR, Cayuela A, Arellano-Orden V, Marin-Caballos A, Padilla V, Ferrandiz-Millon C, et al. Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury. Intensive Care Med 2010;36:1309 -17.

39. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2009,103(Suppl1):3-13.

40. Weil MH, Tang W. Microvascular flow during mechanical cardiopulmonary resuscitation. Resuscitation 2010 Jan;81(1):5. Epub 2009 Dec 9.

41. Puyana JC, Pinsky MR. Searching for non-invasive markers of tissue hypoxia. Crit Care. 2010;14(2):R42. Epub 2010 Mar 23.

42. Fries M, Weil MH, Chang YT, Castillo C, Tang W. Microcirculation during cardiac arrest and resuscitation. Crit Care Med 2006 Dec;34(12 Suppl):S454-7.

43. Anonymous. i-STAT® System, 2008 (cited July 2010). Available:

44. Dascombe BJ, Reaburn PR, Sirotic AC, Coutts AJ. The reliability of the i-STAT clinical portable analyser. J Sci Med Sport 2007;10:135-40.

45. Sediame S, Zerah-Lancner F, d'Ortho MP, Adnot S, Harf A. Accuracy of the i-STAT bedside blood gas analyser. Eur Respir J 1999;14:214-7.

46. Payen D, Luengo C, Heyer L, Resche-Rigon M, Kerever S, Damoisel C, Losser MR. Is thenar tissue hemoglobin oxygen saturation in septic shock related to macrohemodynamic variables and outcome? Crit Care 2009;13 Suppl 5:S6. Epub 2009 Nov 30.

47. Podbregar M, Mozina H. Skeletal muscle oxygen saturation does not estimate mixed venous oxygen saturation in patients with severe left heart failure and additional severe sepsis or septic shock. Crit Care 2007;11(1):116.

48. Mozina H, Podbregar M. Near-infrared spectroscopy during stagnant ischemia estimates central venous oxygen saturation and mixed venous oxygen saturation discrepancy in patients with severe left heart failure and additional sepsis/septic shock. Crit Care 2010;14(2):R42. Epub 2010 Mar 23.

49. Leone M, Blidi S, Antonini F, Meyssignac B, Bordon S, Garcin F, et al. Oxygen tissue saturation is lower in nonsurvivors than in survivors after early resuscitation of septic shock. Anesthesiology 2009 Aug;111(2):366-71.

50. Cohn SM, Nathens AB, Moore FA, Rhee P, Puyana JC, Moore EE, et al.  Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 2007 Jan;62(1):44-54.

51. Zhao D, Weil MH, Tang W, Klouche K, Wann SR. Pupil diameter and light reaction during cardiac arrest and resuscitation. Crit Care Med 2001;29(4):825-8.

52. Condemi A, Donatello G, Mauro M, Spazzolini A, Zocchi C. Importance of puppillary and photomotor reflexex in cardiac resuscitation. Minerva Anestesiol 1981;47(12):885-90.

53. Snyder BD, Gumnit RJ, Leppik IE, Hauser WA, Loewenson RB, Ramirez-Lassepas M. Neurologic prognosis after cardiopulmonary arrest:

IV. Brainstem reflexes. Neurology 1981;31(9):1092-7.

54. Abe T, Tokuda Y, Ishimatsu S, Nagao K, Kikushima K, Sakamoto T, et al. Predictors for good cerebral performance among adult survivors of out-of-hospital cardiac arrest. Resuscitation 2009;80(4):431-6.

55. Marx G, Reinhart K. Venous oximetry. Curr Opin Crit Care 2006;12(3):263-8.

56. Andrews F J, Nolan J P. Critical care in the emergency department: monitoring the critically ill patient. Emerg Med Manual 2006;23(7):561-4.

57. Ahrens T. Hemodynamics in sepsis. AACN Adv Crit Care 2006;17(4):435-45.

58. Reinhart K, Kuhn H J, Hartog C, Bredle D L. Continous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004;30(8):1572-8.

59. Rivers E. Mixed and central venous oxygen saturation may be not numerically equal, but both are still clinically useful. Chest 2006;129(3):507-8.

60. Molnar Z, Umgleter A, Toth I, Livingstone D, Weyland A, Sakka SG, et al. Continous monitoring of ScvO(2) by a new fibre-optic technology compared with blood gas oximetry in critically ill patients: a multicenter study. Intensive Care Med 2007;33(10):1767-70.

61. Bauer P, Reinhart K, Bauer M. Significance of venous oximetry in the critically ill. Med Intensiva 2008;32(3):134-42.

62. Ruiz C, Hernandez G, Ince C. Diagnosis and treatment of the septic microcirculation. In: Vincent JL, editor. 2010 Yearbook of intensive care and emergency medicine, Berlin: Springer-Verlag; 2010. p. 16-26.

63. Lima A, van Bommel J, Jansen TC, Ince C, Bakker J. Low tissue oxygen saturation at the end of early goal-directed therapy is associated with worse outcome in critically ill patients. Crit Care 2009;13 Suppl 5:S13.

64. Di Filippo A, Gonnelli C, Perretta L, Zagli G, Spina R, Chiostri M, et al. Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study. Scand J Trauma Resusc Emerg 2009;17(1):23.

65. Secher NH, van Lieshout JJ. Normovolaemia defined by central blood volume and venous oxygen saturation. Cli Exp Pharmacol Physiol 2005;32(11):901-10.

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