Monitoring during cardiac arrest: are we there yet?
Advancements in electronic data acquisition have translated into improved monitoring of victims of cardiac arrest, but initial techniques remain direct observation of pulses and respirations. The most essential monitor continues to be the electrocardiogram. However, monitoring diastolic blood pressure, myocardial perfusion pressure, and end-tidal carbon dioxide are extremely useful. Most of the current research on monitoring during cardiopulmonary resuscitation focuses on methods for analyzing ventricular fibrillation waveforms. By analyzing the waveform, defibrillation shocks may be delivered at the time when the chance of success is optimal. Low-amplitude and low-frequency fibrillation waveforms are associated with increased rates of asystole and pulseless electrical activity after defibrillation. Methods of analyzing the ventricular fibrillation waveform include measuring the amplitude and frequency and combining the contributions of amplitude and frequency by various methods to improve discrimination. Other types of monitoring being studied for their usefulness during cardiac arrests include sonography, Bispectral Index monitoring, tissue carbon dioxide monitors, and pupil observation. The test of these monitoring techniques is ultimately their ability to improve patient survival to hospital discharge, which is a major challenge for resuscitation researchers.
Hayes
Melinda M
MM
Department of Anesthesiology, The University of Arizona College of Medicine, Tucson, Arizona 85724, USA.
Berg
Robert Allen
RA
Otto
Charles W
CW
D000818:Animals; D002245:Carbon Dioxide / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D004195:Disease Models, Animal; D004452:Echocardiography / Q000379:methods; D004554:Electric Countershock / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D006323:Heart Arrest / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D011680:Pupil / Q000502:physiology; D013552:Swine; D014693:Ventricular Fibrillation / Q000175:diagnosis
D002245:Carbon Dioxide