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Identification of return of spontaneous circulation during cardiopulmonary resuscitation via pulse oximetry in a porcine animal cardiac arrest model

  • Chen Li
  • Jun XuEmail author
  • Fei Han
  • Joseph Walline
  • Liangliang Zheng
  • Yangyang Fu
  • Huadong Zhu
  • Yanfen Chai
  • Xuezhong Yu
Original Research
  • 38 Downloads

Abstract

In this prospective study we investigated whether the pulse oximetry plethysmographic waveform (POP) could be used to identify return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR). Tweleve pigs (28 ± 2 kg) were randomly assigned to two groups: Group I (non-arrested with compressions) (n = 6); Group II (arrested with CPR and defibrillation) (n = 6). Hemodynamic parameters and POP were collected and analyzed. POP was analyzed using both a time domain method and a frequency domain method. In Group I, when compressions were carried out on subjects with a spontaneous circulation, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method. In Group II, after the period of ventricular fibrillation was induced, the POP waveform disappeared. With compressions, POP showed a regular compression wave. After defibrillation, ROSC, and continued compressions, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method, similar to Group I. Analysis of POP using the time and frequency domain methods could be used to identify ROSC during CPR.

Keywords

Cardiac arrest Cardiopulmonary resuscitation Pulse oximetry plethysmographic waveform Identification Return of spontaneous circulation 

Abbreviations

CCs

Chest compressions

CPR

Cardiopulmonary resuscitation

POP

The pulse oximetry plethysmographic waveform

ROSC

Return of spontaneous circulation

CA

Cardiac arrest

PETCO2

Partial pressure of end-tidal carbon dioxide

VF

Ventricular fibrillation

HR

Heart rate

DAP

Diastolic arterial pressure

TDM

The time domain method

FDM

The frequency domain method

Notes

Author contributions

CL conceived and designed the experiments, performed the experiments, analyzed the data and drafted the manuscript. JX conceived and designed the experiments, performed the experiments and finally approved the manuscript. FH analyzed the data. JW helped to draft the manuscript. LZ performed the experiments. YF performed the experiments. HZ, YC and XY helped to finally approve the manuscript. All authors read and approved the final manuscript.

Funding

The study was funded by the National Health and Family Planning Commission of the People’s Republic of China Special Research Fund (201502019) URL: http://www.moh.gov.cn/qjjys/s3577/201401/e9f3635e7acb47778225ccb729ffec62.shtml : Xuezhong Yu received this funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. This experimental protocol was approved by the Animal Care and Use Committee at Peking Union Medical College Hospital (2013S-512).

Supplementary material

10877_2018_230_MOESM1_ESM.mov (8.3 mb)
Supplementary material 1. Video 1. Wave transformation in the frequency domain method at the compression stage in non-arrested animals (MOV 8459 KB)
10877_2018_230_MOESM2_ESM.mov (9.3 mb)
Supplementary material 2. Video 2. Wave transformation in the frequency domain method at the compression stage in cardiac arrested animals with CPR (MOV 9551 KB)

References

  1. 1.
    Edelson DP, Yuen TC, Mancini ME, Davis DP, Hunt EA, Miller JA, Abella BS. Hospital cardiac arrest resuscitation practice in the United States: a nationally representative survey. J Hosp Med. 2014;9(6):353–7.  https://doi.org/10.1002/jhm.2174.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cunningham LM, Mattu A, O’Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012;30(8):1630–8.  https://doi.org/10.1016/j.ajem.2012.02.015.CrossRefPubMedGoogle Scholar
  3. 3.
    Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, Kleinman ME, Kronick SL, Lavonas EJ, Link MS, Mancini ME, Morrison LJ, O’Connor RE, Samson RA, Schexnayder SM, Singletary EM, Sinz EH, Travers AH, Wyckoff MH, Hazinski MF. Part 1: Executive Summary: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):315–67.  https://doi.org/10.1161/CIR.0000000000000252.CrossRefGoogle Scholar
  4. 4.
    Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive care Med. 2015.  https://doi.org/10.1007/s00134-015-4051-3.CrossRefPubMedGoogle Scholar
  5. 5.
    Xu J, Li C, Li Y, Walline J, Zheng L, Fu Y, Yao D, Zhu H, Liu X, Chai Y, Wang Z, Yu X. Influence of chest compressions on circulation during the peri-cardiac arrest period in porcine models. PLoS ONE. 2016;11(5):e0155212.  https://doi.org/10.1371/journal.pone.0155212.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Osorio J, Dosdall DJ, Tabereaux PB, Robichaux RP Jr, Stephens S, Kerby JD, Stickney RE, Pogwizd S, Ideker RE. Effect of chest compressions on ventricular activation. Am J Cardiol. 2012;109(5):670–4.  https://doi.org/10.1016/j.amjcard.2011.10.024.CrossRefPubMedGoogle Scholar
  7. 7.
    Berdowski J, Tijssen JG, Koster RW. Chest compressions cause recurrence of ventricular fibrillation after the first successful conversion by defibrillation in out-of-hospital cardiac arrest. Circ Arrhythm Electrophysiol. 2010;3(1):72–8.  https://doi.org/10.1161/CIRCEP.109.902114.CrossRefPubMedGoogle Scholar
  8. 8.
    Bendjelid K. The pulse oximetry plethysmographic curve revisited. Curr Opin Crit Care. 2008;14(3):348–53.  https://doi.org/10.1097/MCC.0b013e3282fb2dc9.CrossRefPubMedGoogle Scholar
  9. 9.
    Arntz HR, Bossaert LL, Danchin N, Nikolaou NI. European Resuscitation Council Guidelines for Resuscitation 2010 Sect. 5. Initial management of acute coronary syndromes. Resuscitation. 2010;81(10):1353–63.  https://doi.org/10.1016/j.resuscitation.2010.08.016.CrossRefPubMedGoogle Scholar
  10. 10.
    Biarent D, Bingham R, Eich C, Lopez-Herce J, Maconochie I, Rodriguez-Nunez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Sect. 6. Paediatric life support. Resuscitation. 2010;81(10):1364–88.  https://doi.org/10.1016/j.resuscitation.2010.08.012.CrossRefPubMedGoogle Scholar
  11. 11.
    Richmond S, Wyllie J. European Resuscitation Council Guidelines for Resuscitation 2010 Sect. 7. Resuscitation of babies at birth. Resuscitation. 2010;81(10):1389–99.  https://doi.org/10.1016/j.resuscitation.2010.08.018.CrossRefPubMedGoogle Scholar
  12. 12.
    Reisner A, Shaltis PA, McCombie D, Asada HH. Utility of the photoplethysmogram in circulatory monitoring. Anesthesiology. 2008;108(5):950–8.  https://doi.org/10.1097/ALN.0b013e31816c89e1.CrossRefPubMedGoogle Scholar
  13. 13.
    Pizov R, Eden A, Bystritski D, Kalina E, Tamir A, Gelman S. Arterial and plethysmographic waveform analysis in anesthetized patients with hypovolemia. Anesthesiology. 2010;113(1):83–91.  https://doi.org/10.1097/ALN.0b013e3181da839f.CrossRefPubMedGoogle Scholar
  14. 14.
    Xu J, Li C, Zheng L, Han F, Li Y, Walline J, Fu Y, Yao D, Zhang X, Zhang H, Zhu H, Guo S, Wang Z, Yu X. Pulse oximetry: a non-invasive, novel marker for the quality of chest compressions in porcine models of cardiac arrest. PLoS ONE. 2015;10(10):e0139707.  https://doi.org/10.1371/journal.pone.0139707.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, Leary M, Meurer WJ, Peberdy MA, Thompson TM, Zimmerman JL. Part 8: post-cardiac arrest care: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):465–82.  https://doi.org/10.1161/CIR.0000000000000262.CrossRefGoogle Scholar
  16. 16.
    Xu J, Zhu H, Wang Z, Yu X, Walline J. Why do not we use finger pulse oximeter plethysmograph waveform to monitor the effectiveness of cardiopulmonary resuscitation? Resuscitation. 2011;82(7):959.  https://doi.org/10.1016/j.resuscitation.2011.03.030.CrossRefPubMedGoogle Scholar
  17. 17.
    Li C, Xu J, Han F, Zheng L, Fu Y, Yao D, Zhang X, Zhu H, Guo S, Yu X. (2015) The role of pulse oximetry plethysmographic waveform monitoring as a marker of restoration of spontaneous circulation:a pilot study. Zhonghua wei zhong bing ji jiu yi xue 27 (3):203–08.  https://doi.org/10.3760/cma.j.issn.2095-4352.2015.03.009.CrossRefPubMedGoogle Scholar
  18. 18.
    Bullock A, Dodington JM, Donoghue AJ, Langhan ML. Capnography use during intubation and cardiopulmonary resuscitation in the pediatric emergency department. Pediatr Emerg Care. 2017;33(7):457–61.  https://doi.org/10.1097/PEC.0000000000000813.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kodali BS, Urman RD. Capnography during cardiopulmonary resuscitation: current evidence and future directions. J Emerg Trauma Shock. 2014;7(4):332–40.  https://doi.org/10.4103/0974-2700.142778.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Scarth E, Cook T. Capnography during cardiopulmonary resuscitation. Resuscitation. 2012;83(7):789–90.  https://doi.org/10.1016/j.resuscitation.2012.04.002.CrossRefPubMedGoogle Scholar
  21. 21.
    Hsin T, Chun FW, Tao HL. Ultra-long cardiopulmonary resuscitation with thrombolytic therapy for a sudden cardiac arrest patient with pulmonary embolism. Am J Emerg Med. 2014.  https://doi.org/10.1016/j.ajem.2014.04.035.CrossRefPubMedGoogle Scholar
  22. 22.
    Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O’Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):444–64.  https://doi.org/10.1161/CIR.0000000000000261.CrossRefGoogle Scholar
  23. 23.
    Ahrens T, Schallom L, Bettorf K, Ellner S, Hurt G, O’Mara V, Ludwig J, George W, Marino T, Shannon W. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391–8.PubMedGoogle Scholar
  24. 24.
    Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Bottiger B, Group ERCGW. European Resuscitation Council Guidelines for Resuscitation 2010 Sect. 1. Executive summary. Resuscitation. 2010;81(10):1219–76.  https://doi.org/10.1016/j.resuscitation.2010.08.021.CrossRefPubMedGoogle Scholar
  25. 25.
    Meaney PA. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association (vol 128, pg 417, 2013). Circulation. 2013;128(20):E408–8. doi: https://doi.org/10.1161/01.cir.0000437040.13277.4f.CrossRefGoogle Scholar
  26. 26.
    Idris AH, Guffey D, Aufderheide TP, Brown S, Morrison LJ, Nichols P, Powell J, Daya M, Bigham BL, Atkins DL, Berg R, Davis D, Stiell I, Sopko G, Nichol G, Consortium RO. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012;125(24):3004–12.  https://doi.org/10.1161/Circulationaha.111.059535.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Donald MJ, Paterson B. End tidal carbon dioxide monitoring in prehospital and retrieval medicine: a review. Emerg Med J. 2006;23(9):728–30.  https://doi.org/10.1136/emj.2006.037184.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Okamoto H, Hoka S, Kawasaki T, Okuyama T, Takahashi S. Changes in end-tidal carbon dioxide tension following sodium bicarbonate administration: correlation with cardiac output and haemoglobin concentration. Acta Anaesthesiol Scand. 1995;39(1):79–84.CrossRefGoogle Scholar
  29. 29.
    Gonzalez ER, Ornato JP, Garnett AR, Levine RL, Young DS, Racht EM. Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med. 1989;18(9):920–6.CrossRefGoogle Scholar
  30. 30.
    Cantineau JP, Merckx P, Lambert Y, Sorkine M, Bertrand C, Duvaldestin P. Effect of epinephrine on end-tidal carbon dioxide pressure during prehospital cardiopulmonary resuscitation. Am J Emerg Med. 1994;12(3):267–70.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Emergency DepartmentTianjin Medical University General HospitalTianjinChina
  2. 2.Emergency Department, Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijingChina
  3. 3.Institute of Life MonitoringMindray CorporationShenzhenChina
  4. 4.Division of Emergency Medicine, Department of SurgerySaint Louis University HospitalSaint LouisUSA

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