PetCO2, VCO2 and CorPP values in the successful prediction of the return of spontaneous circulation: An experimental study on unassisted induced cardiopulmonary arrest

Abstract

Introduction: During cardiac arrest, end-tidal CO2 (PetCO2), VCO2 and coronary perfusion pressure fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation. Therefore, the monitoring of PetCO2 and VCO2 by capnography is a useful tool during clinical management of cardiac arrest patients. Objective: To assess if PetCO2, VCO2 and coronary perfusion pressure are useful for the prediction of return of spontaneous circulation in an animal model of cardiac arrest/cardiopulmonary resuscitation treated with vasopressor agents. Methods: 42 swine were mechanically ventilated (FiO2=0.21). Ventricular fibrillation was induced and, after 10 min, unassisted cardiac arrest was initiated, followed by compressions. After 2 min of basic cardiopulmonary resuscitation, each group received: Adrenaline, Saline-Placebo, Terlipressin or Terlipressin + Adrenaline. Two minutes later (4th min of cardiopulmonary resuscitation), the animals were defibrillated and the ones that survived were observed for an additional 30 min period. The variables of interest were recorded at the baseline period, 10 min of ventricular fibrillation, 2nd min of cardiopulmonary resuscitation, 4th min of cardiopulmonary resuscitation, and 30 min after return of spontaneous circulation. Results: PetCO2 and VCO2 values, both recorded at 2 min and 4 min of cardiopulmonary resuscitation, have no correlation with the return of spontaneous circulation rates in any group. On the other hand, higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the adrenaline and adrenaline + terlipressin groups. Conclusion: Although higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the animals that received adrenaline or adrenaline + terlipressin, PetCO2 and VCO2 have not been shown to be useful for predicting return of spontaneous circulation rates in this porcine model.