Continuous capnography monitoring during resuscitation in a transitional large mammalian model of asphyxial cardiac arrest.
BACKGROUND
In neonates requiring chest compression (CC) during resuscitation, neonatal resuscitation program (NRP) recommends against relying on a single feedback device such as end-tidal carbon dioxide (ETCO2) or saturations (SpO2) to determine return of spontaneous circulation (ROSC) until more evidence becomes available.


METHODS
We evaluated the role of monitoring ETCO2during resuscitation in a lamb model of cardiac arrest induced by umbilical cord occlusion (n = 21). Lambs were resuscitated as per NRP guidelines. Systolic blood pressure (SBP), carotid and pulmonary blood flows along with ETCO2and blood gases were continuously monitored. Resuscitation was continued for 20 min or until ROSC (whichever was earlier). Adequate CC was arbitrarily defined as generation of 30 mmHg SBP during resuscitation. ETCO2thresholds to predict adequacy of CC and detect ROSC were determined.


RESULTS
Significant relationship between ETCO2and adequate CC was noted during resuscitation (AUC-0.735, P < 0.01). At ROSC (n = 12), ETCO2rapidly increased to 57 ± 20 mmHg with a threshold of ≥32 mmHg being 100% sensitive and 97% specific to predict ROSC.


CONCLUSIONS
In a large mammalian model of perinatal asphyxia, continuous ETCO2monitoring predicted adequacy of CC and detected ROSC. These findings suggest ETCO2in conjunction with other devices may be beneficial during CC and predict ROSC.
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Praveen
P
Chandrasekharan
Division of Neonatology, Department of Pediatrics, UC Davis Health System, Sacramento, California.
Payam
P
Vali
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Munmun
M
Rawat
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Bobby
B
Mathew
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Sylvia F
SF
Gugino
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Carmon
C
Koenigsknecht
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Justin
J
Helman
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Jayasree
J
Nair
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Sara
S
Berkelhamer
Division of Neonatology, Department of Pediatrics, University at Buffalo, Buffalo, New York.
Satyan
S
Lakshminrusimha
D000818:Animals; D001237:Asphyxia / Q000503:physiopathology*; D019296:Capnography; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000503:physiopathology*; D012756:Sheep