Correlation Between End-tidal CO2 and Degree of Compression of Heart During CPR Measured by Ultrasound

Correlation Between End-tidal CO2 and Degree of Compression of Heart Cavities Measured by Transthoracic Ultrasound During Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest

Individual optimization of cardiopulmonary resuscitation (CPR) in real time may increase the success rate of the procedure. End-tidal CO2 (EtCO2) levels reflect cardiac output induced by CPR. Other potential marker of haemodynamic efficacy of CPR is direct measurement of the extent of induced compression of left ventricle (LV), right ventricle (RV) and inferior caval vein (IVC) by ultrasound. We plane to evaluate whether these ultrasound parameters correlate with EtCO2 levels during CPR for out-of-hospital cardiac arrest (OHCA) of non-traumatic origin.

Study Overview

• Status: Unknown
• Conditions: Cardiopulmonary Resuscitation; Echocardiography
• Intervention / Treatment: Diagnostic test: Intra-arrest echocardiography

Detailed Description

Pre-hospital observational study will be realized in the setting of physician-based Emergency Medical System in the Czech republic. 20 patients resuscitated for OHCA of nontraumatic origin are planned to be included to the study. Transthoracic echocardiography will be performed from subcostal view during ongoing chest compressions in all of them and in the time of this investigation EtCO2 level will be recorded. This will be repeated three times during CPR in each patient if possible. Later on, maximal and minimal diameter of LV, RV and IVC will be obtained from the recorded loops and compression index (%) of LV (LVCI), RV (RVCI) and IVC (IVCCI) will be calculated as (maximal-minimal/maximal cavital diameter)x100. Correlations between EtCO2 and LVCI, RVCI and IVCI and CImax will be expressed as Spearman's correlation coefficient.

The results of the study will answer the question whether echocardiographic evaluation of compression of heart cavities during CPR reflect haemodynamic efficacy of CPR. If so, this study will be followed by an interventional clinical trial evaluating the effect of compression depth changes as a response to measured compression of the heart.

• Study Type: Observational
• Enrollment (Anticipated): 20

Contacts and Locations

Study Locations

• Czechia
  • Central Bohemian Region
    • Kladno, Central Bohemian Region, Czechia
      • Recruiting
      • Emergency Medical Service of the Central Bohemian Region
      • Contact: Jitka Callerova, MD; Phone Number: 00420 777 844 471; Email: callerova.hypotermie@email.cz
      • Principal Investigator: Roman Skulec, MD, PhD
      • Sub-Investigator: Petr Vojtisek, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All consecutive patients meeting inclusion and exclusion criteria

Description

Inclusion Criteria:

• Adult patient resuscitated for out-of-hospital cardiac arrest of non-traumatic origin.

Exclusion Criteria:

• Technical unavailability of intra-arrest ultrasonography and capnography.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
OHCA patients; Patients resuscitated for out-of-hospital cardiac arrest of non-traumatic origin and investigated by intra-arrest echocardiography.	Diagnostic test: Intra-arrest echocardiography; Intra-arrest echocardiography performed by portable ultrasound device during ongoing chest compressions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation of EtCO2 level and compression index of left ventricle, right ventricle and inferior caval vein	Compression index of left ventricle, right ventricle and inferior caval vein measured by intra-arrest echocardiography and EtCO2 measured by side stream approach during cardiopulmonary resuscitation.	Participant will be repeatedly evaluated during cardiopulmonary resuscitation. Therefore, anticipated time frame the time interval will fluctuate from 5 minutes to 120 minutes

Collaborators and Investigators

• Sponsor: Emergency Medical Service of the Central Bohemian Region, Czech Republic
• Collaborators: Masaryk Hospital Usti nad Labem

Publications and helpful links

General Publications

• Skulec R, Vojtisek P, Cerny V. Correlation between end-tidal carbon dioxide and the degree of compression of heart cavities measured by transthoracic echocardiography during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Crit Care. 2019 Oct 29;23(1):334. doi: 10.1186/s13054-019-2607-2.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Anticipated): March 15, 2019
• Study Completion (Anticipated): March 31, 2019

Study Registration Dates

• First Submitted: February 21, 2019
• First Submitted That Met QC Criteria: February 21, 2019
• First Posted (Actual): February 25, 2019

Study Record Updates

• Last Update Posted (Actual): February 25, 2019
• Last Update Submitted That Met QC Criteria: February 21, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: 2018-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No