Initial capnography values and resuscitation outcomes of patients assisted by basic life support units in ﬁrst instance; descriptive prospective study
1SAMU 061 Baleares, C/Illes Balears sn. Palma de Mallorca, 07014, Spain
2Phd Department of Nursing and Physiotherapy University of Balearic Islands, Ctra. De Valldemossa, km 7,5 Palma de Mallorca (Islas Baleares), 07122, Spain
DOI: 10.22514/sv.2021.099 Vol.17,Issue 4,July 2021 pp.86-91
Submitted: 09 December 2020 Accepted: 05 February 2021
Published: 08 July 2021
Introduction: Understanding the key factors which affect out hospital cardiac arrest (OHCA) outcomes is essential in order to promote patient treatment. The main objective of this research was to describe the correlations between the capnographic values obtained during the first minute of monitoring on cardiopulmonary resuscitation, assisted by basic life-support units, with the results as return of spontaneous circulation (ROSC) and alive hospital admission. The secondary objectives were to describe the sociodemographic characteristics of the patients assisted, and to analyze any correlations between receiving basic life-support units and/or defibrillation prior to the arrival of basic life-support units, and the results of the cardiopulmonary resuscitation maneuvers.
Methods: A prospective, descriptive, observational study of adult non-traumatic out hospital cardiac arrest patients was conducted. The patients were initially assisted by basic life-support units on the island of Mallorca, with one minute of initial capnography monitoring.
Results: From July 2018 to March 2020, fifty-nine patients meeting the inclusion criteria were assisted, 76% were men and their mean age was 64.45 (±15.07) years old. The number of emergency lifesaving technicians who participated in the study was 58, they had a mean work experience of 14.05 (±6.7) years. Thirty-seven (63.7%) patients underwent basic life-support by bystanders and in 91.5% of cases the semi-automatic external defibrillator was used. Capnometry values during the first minute were obtained in 34 (58.6%) patients, their mean values were 22 (±19.07) mmHg, 35.5% of patients had values <10 mmHg. In 25.4% of the patients, spontaneous circulation returned during cardiopulmonary resuscitation, and 18.6% were admitted to hospital alive.
Conclusion: No correlations were found between initial capnography values scoring above or below 10 mmHg and survival, however, basic life-support maneuvers, and defibrillation by bystanders and first responders, did correlate with survival rates. The average patient assisted in out of hospital cardiac arrest by the basic life-support units sampled was an adult male aged over 65 years.
Capnography; Heart arrest; Cardiopulmonary resuscitation
Francisco José Cereceda-Sánchez,Jaume Ponce-Taylor,Pedro Montero-París,Iñaki Unzaga-Ercilla,Natalia Martinez-Cuellar,Jesús Molina-Mula. Initial capnography values and resuscitation outcomes of patients assisted by basic life support units in ﬁrst instance; descriptive prospective study. Signa Vitae. 2021. 17(4);86-91.
 Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015; 95: 81–99.
 Michelland L, Adnet F, Escutnaire J, Baker C, Hubert H, Chevret S. Association between early advanced life support and good neurological outcome in out of hospital cardiac arrest: a propensity score analysis. Journal of Evaluation in Clinical Practice. 2020; 26: 1013–1021.
 Christopher Kurz M, Schmicker RH, Leroux B, Nichol G, Aufderheide TP, Cheskes S, et al. Advanced vs. basic life support in the treatment of out-of-hospital cardiopulmonary arrest in the resuscitation outcomes consortium. Resuscitation. 2018; 128: 132–137.
 Chang MP, Idris AH. The past, present, and future of ventilation during cardiopulmonary resuscitation. Current Opinion in Critical Care. 2017; 23: 188–192.
 Newell C, Grier S, Soar J. Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation. Critical Care. 2018; 22: 190.
 Marquez AM, Morgan RW, Ross CE, Berg RA, Sutton RM. Physiology-directed cardiopulmonary resuscitation: advances in precision monitor-ing during cardiac arrest. Current Opinion in Critical Care. 2018; 24: 143–150.
 Kalenda Z. The capnogram as a guide to the efficacy of cardiac massage. Resuscitation. 1978; 6: 259–263.
 Sandroni C, De Santis P, D’Arrigo S. Capnography during cardiac arrest. Resuscitation. 2018; 132: 73–77.
 Poon KM, Lui CT, Tsui KL. Prognostication of out-of-hospital cardiac arrest patients by 3-min end-tidal capnometry level in emergency department. Resuscitation. 2016; 102: 80–84.
 Chen J, Lee Y, Hou S, Huang M, Hsu C, Su Y. End-tidal carbon dioxide monitoring may be associated with a higher possibility of return of spontaneous circulation during out-of-hospital cardiac arrest: a population-based study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2015; 23: 104.
 Wang A-Y, Huang C-H, Chang W-T, Tsai M-S, Wang C-H, Chen W-J. Initial end-tidal CO2 partial pressure predicts outcomes of in-hospital cardiac arrest. The American Journal of Emergency Medicine. 2016; 34: 2367–2371.
 Pantazopoulos C, Xanthos T, Pantazopoulos I, Papalois A, Kouskouni E, Iacovidou N. A review of carbon dioxide monitoring during adult cardiopulmonary resuscitation. Heart, Lung & Circulation. 2015; 24: 1053–1061.
 Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, et al. Part 4: Advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015; 132: S84–S145.
 Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. Adult advanced life support: Section 3 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015; 95: 100–147.
 Voss S, Rhys M, Coates D, Greenwood R, Nolan JP, Thomas M, et al. How do paramedics manage the airway during out of hospital cardiac arrest? Resuscitation. 2014; 85: 1662–1666.
 Ballesteros Peña S. Unidades de soporte vital básico y avanzado en España: análisis de la situación actual. Anales del Sistema Sanitario de Navarra. 2012; 35: 219–228. (In Spanish)
 Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveen-gen T, et al. Adult basic life support and automated external defibrillation: Section 2 of the European Resuscitation Council Guidelines for Resuscitation 2015. Notfall und Rettungsmedizin. 2015; 18: 748–769.
 Krishna CK, Showkat HI, Taktani M, Khatri V. Out of hospital cardiac arrest resuscitation outcome in North India—CARO study. World Journal of Emergency Medicine. 2017; 8: 200.
 Grmec S, Klemen P. Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?European Journal of Emergency Medicine. 2001; 8: 263–269.
 Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015; 95: 100–147.
 Nakatani K, Yukioka H, Fujimori M, Maeda C, Noguchi H, Ishihara S, et al. Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation. American Journal of Emergency Medicine. 1999; 17: 203–206.
 Blank D, Rich W, Leone T, Garey D, Finer N. Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation. Resuscitation. 2014; 85: 1568–1572.
 Grunau B, Kawano T, Scheuermeyer F, Tallon J, Reynolds J, Besserer F, et al. Early advanced life support attendance is associated with improved survival and neurologic outcomes after non-traumatic out-of-hospital cardiac arrest in a tiered prehospital response system. Resuscitation. 2018; 135: 137–144.
 Sheak KR, Wiebe DJ, Leary M, Babaeizadeh S, Yuen TC, Zive D, et al. Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest. Resuscitation. 2015; 89: 149–154.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.