TY - JOUR
T1 - Chest compressions induce errors in end-tidal carbon dioxide measurement
AU - Leturiondo, Mikel
AU - Ruiz de Gauna, Sofía
AU - Gutiérrez, José Julio
AU - Alonso, Daniel
AU - Corcuera, Carlos
AU - Urtusagasti, Juan Francisco
AU - González-Otero, Digna María
AU - Russell, James Knox
AU - Daya, Mohamud Ramzan
AU - Ruiz, Jesus María
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/8
Y1 - 2020/8
N2 - Background: Real-time measurement of end-tidal carbon dioxide (ETCO2) is used as a non-invasive estimate of cardiac output and perfusion during cardiopulmonary resuscitation (CPR). However, capnograms are often distorted by chest compressions (CCs) and this may affect ETCO2 measurement. The aim of the study was to quantify the effect of CC-artefact on the accuracy of ETCO2 measurements obtained during out-of-hospital manual CPR. Methods: We retrospectively analysed monitor-defibrillator recordings collected by two advanced life support agencies during out-of-hospital cardiac arrest. These two agencies, represented as A and B used different side-stream capnometers and monitor-defibrillators. One-minute capnogram segments were reviewed. Each ventilation within each segment was identified using the transthoracic impedance signal and the capnogram. ETCO2 values per ventilation were manually annotated and compared to the corresponding capnometry values stored in the monitor-defibrillator. Ventilations were classified as distorted or non-distorted by CC-artefact. Results: A total of 407 1-min capnogram segments from 65 patients were analysed. Overall, 4095 ventilations were annotated, 2170 (32.4% distorted) and 1925 (31.8% distorted) for agency A and B, respectively. Median (IQR) unsigned error in ETCO2 measurement increased from 1.5 (0.6–3.1)% for non-distorted to 5.5 (1.8–14.1)% for distorted ventilations; from 0.7 (0.3–1.2)% to 3.7 (1.0–9.9)% in agency A and from 2.3 (1.2–3.9)% to 8.3 (3.9–19.5)% in agency B (p < 0.001). Errors were higher than 10 mmHg in 9% and higher than 15 mmHg in 5% of the distorted ventilations. Conclusion: CC-artefact causes ETCO2 measurement errors in the two studied devices. This suggests that capnometer algorithms may need to be adapted to reliably perform in the presence of CC-artefact during CPR.
AB - Background: Real-time measurement of end-tidal carbon dioxide (ETCO2) is used as a non-invasive estimate of cardiac output and perfusion during cardiopulmonary resuscitation (CPR). However, capnograms are often distorted by chest compressions (CCs) and this may affect ETCO2 measurement. The aim of the study was to quantify the effect of CC-artefact on the accuracy of ETCO2 measurements obtained during out-of-hospital manual CPR. Methods: We retrospectively analysed monitor-defibrillator recordings collected by two advanced life support agencies during out-of-hospital cardiac arrest. These two agencies, represented as A and B used different side-stream capnometers and monitor-defibrillators. One-minute capnogram segments were reviewed. Each ventilation within each segment was identified using the transthoracic impedance signal and the capnogram. ETCO2 values per ventilation were manually annotated and compared to the corresponding capnometry values stored in the monitor-defibrillator. Ventilations were classified as distorted or non-distorted by CC-artefact. Results: A total of 407 1-min capnogram segments from 65 patients were analysed. Overall, 4095 ventilations were annotated, 2170 (32.4% distorted) and 1925 (31.8% distorted) for agency A and B, respectively. Median (IQR) unsigned error in ETCO2 measurement increased from 1.5 (0.6–3.1)% for non-distorted to 5.5 (1.8–14.1)% for distorted ventilations; from 0.7 (0.3–1.2)% to 3.7 (1.0–9.9)% in agency A and from 2.3 (1.2–3.9)% to 8.3 (3.9–19.5)% in agency B (p < 0.001). Errors were higher than 10 mmHg in 9% and higher than 15 mmHg in 5% of the distorted ventilations. Conclusion: CC-artefact causes ETCO2 measurement errors in the two studied devices. This suggests that capnometer algorithms may need to be adapted to reliably perform in the presence of CC-artefact during CPR.
KW - Advanced life support
KW - Capnometry
KW - Cardiopulmonary resuscitation
KW - Chest compressions
KW - End-tidal CO2
KW - Ventilations
KW - Waveform capnography
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U2 - 10.1016/j.resuscitation.2020.05.029
DO - 10.1016/j.resuscitation.2020.05.029
M3 - Article
C2 - 32492455
AN - SCOPUS:85087358498
SN - 0300-9572
VL - 153
SP - 195
EP - 201
JO - Resuscitation
JF - Resuscitation
ER -