The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes. Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes.
1. Is first pass success of orotracheal intubation important? [1]
- What they did:
- Is there an association of first pass intubation success with incidence of adverse events (AEs)?
- Retrospective analysis
- 1,828 orotracheal intubations
- Single academic ED
- Primary Outcomes:
- AEs: aspiration, oxygen desaturation, dental trauma, laryngospasm, pneumothorax, esophageal intubation, hypotension, dysrhythmia, and cardiac arrest
- Results:
- Most common AE was oxygen desaturation
- First attempt success = 14.2% AEs
- Two attempts = 47.2% AEs
- Three attempts = 63.6% AEs
- Four or more attempts = 70.6% AEs
- Limitations:
- Single center study
- Retrospective analysis
- Data was self-reported which could cause recall bias and under reporting of AEs
- Conclusion: As the number of attempts increases, the incidence of AEs increases substantially
2. Does the rate of CPR matter? [2]
- What they did:
- Prospective observational study
- 3 hospitals
- 97 cardiac arrests
- Measured chest compression rates
- Primary Outcome:
- Return of spontaneous circulation (ROSC)
- Results:
- CPR rate
- CPR rate
- CPR rate of patients with ROSC 90 +/- 17
- CPR rate of non-survivors 79 +/- 18
- Limitation:
- Data collected from an observer (human error)
- Conclusion: Suboptimal chest compression rates correlate with poor ROSC.
3. How important is the End-Tidal Carbon Dioxide in cardiac arrest? [3]
- What they did:
- Prospective, observational study
- 737 cases of out-of-hospital cardiac arrest
- Recorded the partial pressure of end-tidal carbon dioxide (PetCO2) measured during CPR
- Primary Outcome:
- PetCO2 predicting restoration of spontaneous circulation (ROSC)
- Results:
- Average PetCO2 = 6.9 +/- 2.2 mmHg in patients without ROSC
- Average PetCO2 = 32.8 +/- 9.1 mmHg in patients with ROSC
- PetCO2
- Conclusions: PetCO2 > 14.3 mmHg after 20 minutes of ACLS predicts ROSC with accuracy
Summary
First pass intubation success, high-quality chest compressions at rate of 100 bpm, and PetCO2 >14.3 mmHg during CPR are important predictors for success in the resuscitation of patients in cardiac arrest. [4]
References:
- Sakles JC et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med 2013. PMID: 23574475
- Abella BS et al. Chest Compression Rates During Cardiopulmonary Resuscitation are Suboptimal: A Prospective Study During In-Hospital Cardiac Arrest. Circulation 2005. PMID: 15687130
- Kolar M et al. PArtial Pressure of End-Tidal Carbon Dioxide Successful Predicts Cardiopulmonary Resuscitation in the Field: A Prospective Observational Study. Critical Care 2008. PMID: 18786260
- Abella BS. The Importance of Cardiopulmonary Resuscitation Quality. Currently Open Crit Care 2013. PMID: 23587758
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