Evaluation of an end-tidal CO2 detector during cardiopulmonary resuscitation in a canine model for pediatric cardiac arrest.
ABSTRACT Our objective was to evaluate a colorimetric end-tidal CO2 detector in a canine model for pediatric cardiac arrest. In a prospective unblinded study, cardiac arrest was induced in 11 anesthetized and paralyzed puppies, weighing 5.0 to 6.1 kg, by clamping the endotracheal tube (ETT) and discontinuing mechanical ventilation. During cardiopulmonary resuscitation (CPR), the detector and the capnometer were connected between the ETT and ventilator tubing. Color shades on the detector ranged from 1 (purple) to 6 (yellow) corresponding to increasing concentrations of CO2. End-tidal CO2 concentrations as indicated by detector color and capnometric reading were monitored and recorded throughout the study. The results showed that there was a significant correlation between the detector color score and capnometric readings (P < 0.001). A sudden rise in end-tidal CO2 indicated by both the capnometer and the detector occurred at return of spontaneous circulation (ROSC) in seven or < 1 minute before ROSC in four animals. This association was significant (P = 0.0009). We conclude that these results demonstrate that, in a canine model for pediatric cardiac arrest, the detector readings correlate with capnometry during CPR and indicate ROSC.
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ABSTRACT: To systematically examine the evidence on patient monitoring before, during, and following veterinary CPR and to identify scientific knowledge gaps. Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) monitoring domain members, by the RECOVER committee and opened for comments by veterinary professionals for 3 months. Academia, referral practice, and general practice. Eighteen worksheets evaluated monitoring practices relevant for diagnosing cardiopulmonary arrest (CPA), monitoring CPR efforts, identifying return of spontaneous circulation (ROSC), and post-ROSC monitoring. Although veterinary clinical trials are lacking, experimental literature using canine models and human clinical trials provided relevant data. The major conclusions from this analysis of the literature highlight the utility of end-tidal carbon dioxide (EtCO(2)) monitoring to identify ROSC and possibly to evaluate quality of CPR. In addition, recommendations for ECG analysis during CPR were addressed. Unless the patient is instrumented at the time of CPA, other monitoring devices (eg, Doppler flow probe) are likely not useful for diagnosis of CPA, and the possibility of pulseless electrical activity makes ECG inappropriate as a sole diagnostic tool. Optimal monitoring of the intra- and postcardiac arrest patient remains to be determined in clinical veterinary medicine, and further evaluation of the prognostic and prescriptive utility of EtCO(2) monitoring will provide material for future studies in veterinary CPR.06/2012; 22 Suppl 1(s1):S65-84. DOI:10.1111/j.1476-4431.2012.00751.x
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ABSTRACT: To present a series of evidence-based, consensus guidelines for veterinary CPR in dogs and cats. Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Questions in five domains were examined: Preparedness and Prevention, Basic Life Support, Advanced Life Support, Monitoring, and Post-Cardiac Arrest Care. Standardized worksheet templates were used for each question, and the results reviewed by the domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 4 weeks. Clinical guidelines were devised from these findings and again reviewed and commented on by the different entities within RECOVER as well as by veterinary professionals. Academia, referral practice and general practice. A total of 74 worksheets were prepared to evaluate questions across the five domains. A series of 101 individual clinical guidelines were generated. In addition, a CPR algorithm, resuscitation drug-dosing scheme, and postcardiac arrest care algorithm were developed. Although many knowledge gaps were identified, specific clinical guidelines for small animal veterinary CPR were generated from this evidence-based process. Future work is needed to objectively evaluate the effects of these new clinical guidelines on CPR outcome, and to address the knowledge gaps identified through this process.06/2012; 22 Suppl 1(s1):S102-31. DOI:10.1111/j.1476-4431.2012.00757.x
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ABSTRACT: We aimed to determine if providers could detect simulated spontaneous respirations of an intubated neonate by palpating gas flow changes at the positive end expiratory pressure valve of a T-piece resuscitation device in an in vitro setting. We also aimed to demonstrate whether the sensitivity of this methodology was related to the exhaled tidal volumes and/or the gas flow settings on the resuscitation device. A T-piece resuscitator (Neopuff®) circuit was connected to a neonatal silicon test lung. Expiratory tidal volumes of 5, 10 and 15 ml were provided via the test lung, with the Neopuff® set at gas flow rates of 5, 10 and 15 L/min. Physician volunteers were asked to identify whether they could detect expiratory gas from the test lung at the circuit T-piece with the volar surface of their wrist, at different tidal volumes and gas flows. Ten doctors detected 315 of 450 expirations; 95, 73 and 42 % of tidal volumes of 15, 10 and 5 ml, respectively, were detected with an overall positive predictive value of 98.7 %. Detection of exhalations was similar at different gas flow rates for each tidal volume. No exhalations were detected at zero gas flow. We concluded that T-piece gas flow palpation may be a useful and previously unreported clinical sign, which may help to reassure clinicians that they have successfully intubated the trachea. As with any clinical sign, it should not be considered in isolation but within the context of the clinical picture.European Journal of Pediatrics 12/2012; 172(4). DOI:10.1007/s00431-012-1911-5 · 1.98 Impact Factor