Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest. (May 2019)

• Record Type: Journal Article
• Authors: Chicote, Beatriz; Aramendi, Elisabete; Irusta, Unai; Owens, Pamela; Daya, Mohamud; Idris, Ahamed
• Is Part Of: Resuscitation. Volume 138(2019)
• Page Start: 74
• Page End: 81
• Publication Date: 2019-05
• Subjects: Ventricular fibrillation -- Shock outcome prediction -- End-tidal CO2 (EtCO2) -- Out-of-hospital cardiac arrest -- Amplitude spectrum area (AMSA) -- Fuzzy entropy; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.02.028
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background and aim: Unsuccessful defibrillation shocks adversely affect survival from out-of-hospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-of-choice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO2 (EtCO2 ) could improve the prediction. The aim of this study was to evaluate EtCO2 as predictor of shock success, both individually and in combination with VF-waveform analysis. Materials and methods: In total 514 shocks from 214 OHCA patients (75 first shocks) were analysed. For each shock three predictors of defibrillation success were automatically calculated from the device files: two VF-waveform features, amplitude spectrum area (AMSA) and fuzzy entropy (FuzzyEn), and the median EtCO2 (MEtCO2 ) in the minute before the shock. Sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated, for each predictor individually and for the combination of MEtCO2 and VF-waveform predictors. Separate analyses were done for first shocks and all shocks. Results: MEtCO2 in first shocks was significantly higher for successful than for unsuccessful shocks (31 mmHg/25 mmHg, p < 0.05), but differences were not significant for all shocks (32 mmHg/29 mmHg, p > 0.05). MEtCO2 predicted shock success with an AUC of 0.66 for first shocks, but was not a predictor for all shocks (AUC 0.54). AMSA and FuzzyEn presented AUCs of 0.76 and 0.77 for first shocks, and 0.75 and 0.75 for all shocks. For first shocks, adding MEtCO2 improved the AUC of AMSA and FuzzyEn to 0.79 and 0.83, respectively. Conclusions: MEtCO2 predicted defibrillation success only for first shocks. Adding MEtCO2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform features and MEtCO2 were automatically calculated from the device files, so these methods could be introduced in current defibrillators adding only new software.