Guillaume Debaty , Nicolas Segond , Helene Duhem , Christophe Crespi , Alexandre Behouche , Johanna Boeuf , Caroline Sanchez , Tahar Chouihed , Johanna Moore , Keith Lurie , José Labarere
{"title":"自动抬头与传统心肺复苏术的潮气末二氧化碳水平比较：前-后干预试验。","authors":"Guillaume Debaty , Nicolas Segond , Helene Duhem , Christophe Crespi , Alexandre Behouche , Johanna Boeuf , Caroline Sanchez , Tahar Chouihed , Johanna Moore , Keith Lurie , José Labarere","doi":"10.1016/j.resuscitation.2024.110406","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO<sub>2</sub>, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.</div></div><div><h3>Method</h3><div>We conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022.<!--> <!-->Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO<sub>2</sub> value measured during CPR.</div></div><div><h3>Results</h3><div>122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO<sub>2</sub> values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO<sub>2</sub> values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, <em>P</em> < 0.001). Mean differences in peak ETCO<sub>2</sub> between study periods did not vary according to the first recorded cardiac rhythm (<em>P</em> for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.</div></div><div><h3>Conclusion</h3><div>ETCO<sub>2</sub> values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110406"},"PeriodicalIF":6.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of end tidal CO2 levels between automated head up and conventional cardiopulmonary resuscitation: A pre-post intervention trial\",\"authors\":\"Guillaume Debaty , Nicolas Segond , Helene Duhem , Christophe Crespi , Alexandre Behouche , Johanna Boeuf , Caroline Sanchez , Tahar Chouihed , Johanna Moore , Keith Lurie , José Labarere\",\"doi\":\"10.1016/j.resuscitation.2024.110406\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO<sub>2</sub>, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.</div></div><div><h3>Method</h3><div>We conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022.<!--> <!-->Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO<sub>2</sub> value measured during CPR.</div></div><div><h3>Results</h3><div>122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO<sub>2</sub> values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO<sub>2</sub> values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, <em>P</em> < 0.001). Mean differences in peak ETCO<sub>2</sub> between study periods did not vary according to the first recorded cardiac rhythm (<em>P</em> for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.</div></div><div><h3>Conclusion</h3><div>ETCO<sub>2</sub> values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.</div></div>\",\"PeriodicalId\":21052,\"journal\":{\"name\":\"Resuscitation\",\"volume\":\"204 \",\"pages\":\"Article 110406\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Resuscitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0300957224003009\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Resuscitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300957224003009","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Comparison of end tidal CO2 levels between automated head up and conventional cardiopulmonary resuscitation: A pre-post intervention trial
Background
The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO2, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.
Method
We conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022. Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO2 value measured during CPR.
Results
122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO2 values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO2 values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, P < 0.001). Mean differences in peak ETCO2 between study periods did not vary according to the first recorded cardiac rhythm (P for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.
Conclusion
ETCO2 values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.
期刊介绍：
Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
