Robert M Sutton1, Benjamin French2, Peter A Meaney3, Alexis A Topjian3, Christopher S Parshuram4, Dana P Edelson5, Stephen Schexnayder6, Benjamin S Abella7, Raina M Merchant7, Melania Bembea8, Robert A Berg3, Vinay M Nadkarni3. 1. The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@chop.edu. 2. University of Pennsylvania School of Medicine, Department of Biostatistics and Epidemiology, 423 Guardian Drive, Philadelphia, PA 19104, United States. 3. The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. 4. Hospital for Sick Children, Department of Pediatrics 555 University Avenue, Toronto, Ontario, Canada. 5. University of Chicago, Department of Emergency Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, United States. 6. University of Arkansas College of Medicine/Arkansas Children's Hospital, Department of Pediatrics, One Children's Way, S-4415, Little Rock, AR 72202, United States. 7. The Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104, United States. 8. Johns Hopkins Hospital/The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 6318B Baltimore, MD 21287, United States.
Abstract
AIM: The American Heart Association (AHA) recommends monitoring cardiopulmonary resuscitation (CPR) quality using end tidal carbon dioxide (ETCO2) or invasive hemodynamic data. The objective of this study was to evaluate the association between clinician-reported physiologic monitoring of CPR quality and patient outcomes. METHODS: Prospective observational study of index adult in-hospital CPR events using the AHA's Get With The Guidelines - Resuscitation Registry. Physiologic monitoring was defined using specific database questions regarding use of either ETCO2 or arterial diastolic blood pressure (DBP) to monitor CPR quality. Logistic regression was used to evaluate the association between physiologic monitoring and outcomes in a propensity score matched cohort. RESULTS: In the matched cohort, (monitored n=3032; not monitored n=6064), physiologic monitoring of CPR quality was associated with a higher rate of return of spontaneous circulation (ROSC; OR 1.22, CI95 1.04-1.43, p=0.017) compared to no monitoring. Survival to hospital discharge (OR 1.04, CI95 0.91-1.18, p=0.57) and survival with favorable neurological outcome (OR 0.97, CI95 0.75-1.26, p=0.83) were not different between groups. Of index events with only ETCO2 monitoring indicated (n=803), an ETCO2 >10mmHg during CPR was reported in 520 (65%), and associated with improved survival to hospital discharge (OR 2.41, CI95 1.35-4.30, p=0.003), and survival with favorable neurological outcome (OR 2.31, CI95 1.31-4.09, p=0.004) compared to ETCO2 ≤10mmHg. CONCLUSION: Clinician-reported use of either ETCO2 or DBP to monitor CPR quality was associated with improved ROSC. An ETCO2 >10mmHg during CPR was associated with a higher rate of survival compared to events with ETCO2 ≤10mmHg.
AIM: The American Heart Association (AHA) recommends monitoring cardiopulmonary resuscitation (CPR) quality using end tidal carbon dioxide (ETCO2) or invasive hemodynamic data. The objective of this study was to evaluate the association between clinician-reported physiologic monitoring of CPR quality and patient outcomes. METHODS: Prospective observational study of index adult in-hospital CPR events using the AHA's Get With The Guidelines - Resuscitation Registry. Physiologic monitoring was defined using specific database questions regarding use of either ETCO2 or arterial diastolic blood pressure (DBP) to monitor CPR quality. Logistic regression was used to evaluate the association between physiologic monitoring and outcomes in a propensity score matched cohort. RESULTS: In the matched cohort, (monitored n=3032; not monitored n=6064), physiologic monitoring of CPR quality was associated with a higher rate of return of spontaneous circulation (ROSC; OR 1.22, CI95 1.04-1.43, p=0.017) compared to no monitoring. Survival to hospital discharge (OR 1.04, CI95 0.91-1.18, p=0.57) and survival with favorable neurological outcome (OR 0.97, CI95 0.75-1.26, p=0.83) were not different between groups. Of index events with only ETCO2 monitoring indicated (n=803), an ETCO2 >10mmHg during CPR was reported in 520 (65%), and associated with improved survival to hospital discharge (OR 2.41, CI95 1.35-4.30, p=0.003), and survival with favorable neurological outcome (OR 2.31, CI95 1.31-4.09, p=0.004) compared to ETCO2 ≤10mmHg. CONCLUSION: Clinician-reported use of either ETCO2 or DBP to monitor CPR quality was associated with improved ROSC. An ETCO2 >10mmHg during CPR was associated with a higher rate of survival compared to events with ETCO2 ≤10mmHg.
Authors: Vinay M Nadkarni; Gregory Luke Larkin; Mary Ann Peberdy; Scott M Carey; William Kaye; Mary E Mancini; Graham Nichol; Tanya Lane-Truitt; Jerry Potts; Joseph P Ornato; Robert A Berg Journal: JAMA Date: 2006-01-04 Impact factor: 56.272
Authors: R O Cummins; D Chamberlain; M F Hazinski; V Nadkarni; W Kloeck; E Kramer; L Becker; C Robertson; R Koster; A Zaritsky; L Bossaert; J P Ornato; V Callanan; M Allen; P Steen; B Connolly; A Sanders; A Idris; S Cobbe Journal: Resuscitation Date: 1997-04 Impact factor: 5.262
Authors: Robert M Sutton; Stuart H Friess; Utpal Bhalala; Matthew R Maltese; Maryam Y Naim; George Bratinov; Dana Niles; Vinay M Nadkarni; Lance B Becker; Robert A Berg Journal: Resuscitation Date: 2012-11-07 Impact factor: 5.262
Authors: J Hope Kilgannon; Alan E Jones; Joseph E Parrillo; R Phillip Dellinger; Barry Milcarek; Krystal Hunter; Nathan I Shapiro; Stephen Trzeciak Journal: Circulation Date: 2011-05-23 Impact factor: 29.690
Authors: J Hope Kilgannon; Alan E Jones; Nathan I Shapiro; Mark G Angelos; Barry Milcarek; Krystal Hunter; Joseph E Parrillo; Stephen Trzeciak Journal: JAMA Date: 2010-06-02 Impact factor: 56.272
Authors: Peter A Meaney; Vinay M Nadkarni; Karl B Kern; Julia H Indik; Henry R Halperin; Robert A Berg Journal: Crit Care Med Date: 2010-01 Impact factor: 7.598
Authors: Caitlin E O'Brien; Polan T Santos; Michael Reyes; Shawn Adams; C Danielle Hopkins; Ewa Kulikowicz; Jennifer L Hamrick; Justin T Hamrick; Jennifer K Lee; Sapna R Kudchadkar; Elizabeth A Hunt; Raymond C Koehler; Donald H Shaffner Journal: Resuscitation Date: 2019-08-04 Impact factor: 5.262
Authors: Robert M Sutton; Heather A Wolfe; Ron W Reeder; Tageldin Ahmed; Robert Bishop; Matthew Bochkoris; Candice Burns; J Wesley Diddle; Myke Federman; Richard Fernandez; Deborah Franzon; Aisha H Frazier; Stuart H Friess; Kathryn Graham; David Hehir; Christopher M Horvat; Leanna L Huard; William P Landis; Tensing Maa; Arushi Manga; Ryan W Morgan; Vinay M Nadkarni; Maryam Y Naim; Chella A Palmer; Carleen Schneiter; Matthew P Sharron; Ashley Siems; Neeraj Srivastava; Sarah Tabbutt; Bradley Tilford; Shirley Viteri; Robert A Berg; Michael J Bell; Joseph A Carcillo; Todd C Carpenter; J Michael Dean; Ericka L Fink; Mark Hall; Patrick S McQuillen; Kathleen L Meert; Peter M Mourani; Daniel Notterman; Murray M Pollack; Anil Sapru; David Wessel; Andrew R Yates; Athena F Zuppa Journal: JAMA Date: 2022-03-08 Impact factor: 157.335
Authors: Robert M Sutton; Ron W Reeder; William P Landis; Kathleen L Meert; Andrew R Yates; Ryan W Morgan; John T Berger; Christopher J Newth; Joseph A Carcillo; Patrick S McQuillen; Rick E Harrison; Frank W Moler; Murray M Pollack; Todd C Carpenter; Daniel A Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg Journal: Crit Care Med Date: 2019-11 Impact factor: 7.598
Authors: Ryan W Morgan; Robert M Sutton; Michael Karlsson; Andrew J Lautz; Constantine D Mavroudis; William P Landis; Yuxi Lin; Sejin Jeong; Nancy Craig; Vinay M Nadkarni; Todd J Kilbaugh; Robert A Berg Journal: Am J Respir Crit Care Med Date: 2018-04-01 Impact factor: 30.528
Authors: Jasmeet Soar; Bernd W Böttiger; Pierre Carli; Keith Couper; Charles D Deakin; Therese Djärv; Carsten Lott; Theresa Olasveengen; Peter Paal; Tommaso Pellis; Gavin D Perkins; Claudio Sandroni; Jerry P Nolan Journal: Notf Rett Med Date: 2021-06-08 Impact factor: 0.826
Authors: Jasmeet Soar; Katherine M Berg; Lars W Andersen; Bernd W Böttiger; Sofia Cacciola; Clifton W Callaway; Keith Couper; Tobias Cronberg; Sonia D'Arrigo; Charles D Deakin; Michael W Donnino; Ian R Drennan; Asger Granfeldt; Cornelia W E Hoedemaekers; Mathias J Holmberg; Cindy H Hsu; Marlijn Kamps; Szymon Musiol; Kevin J Nation; Robert W Neumar; Tonia Nicholson; Brian J O'Neil; Quentin Otto; Edison Ferreira de Paiva; Michael J A Parr; Joshua C Reynolds; Claudio Sandroni; Barnaby R Scholefield; Markus B Skrifvars; Tzong-Luen Wang; Wolfgang A Wetsch; Joyce Yeung; Peter T Morley; Laurie J Morrison; Michelle Welsford; Mary Fran Hazinski; Jerry P Nolan Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262
Authors: Robert M Sutton; Ron W Reeder; William Landis; Kathleen L Meert; Andrew R Yates; John T Berger; Christopher J Newth; Joseph A Carcillo; Patrick S McQuillen; Rick E Harrison; Frank W Moler; Murray M Pollack; Todd C Carpenter; Daniel A Notterman; Richard Holubkov; J Michael Dean; Vinay M Nadkarni; Robert A Berg Journal: Resuscitation Date: 2018-07-18 Impact factor: 6.251