Abstract 86: CPR Parameters as Predictors of Return of Spontaneous Circulation Following Inpatient Cardiac Arrest

Abstract

Background: The quality of cardiopulmonary resuscitation (CPR) parameters, including chest compression fraction (CCF) and compression depth, appear to be associated with return of spontaneous circulation (ROSC) in out-of-hospital cardiopulmonary arrest (CPA). In addition, end tidal carbon dioxide (EtCO2) may be useful as a marker for ROSC during low flow states such as CPA. Objective: To explore the relationship between CCF, compression depth, and EtCO2 for inpatient CPA. Methods: This study was conducted in two urban university hospitals. Defibrillator data are exported for analysis following all CPA events. Inpatient medical records were reviewed to determine baseline characteristics and outcomes. CPR data were analyzed in 1-min intervals over the entire CPA resuscitation. The pattern of CCF, compression depth, and EtCO2 were explored in ventricular fibrillation (VF) and non-VF patients and in those with and without ROSC. Results: A total of 23 CPAs were analyzed between 5/31/09 and 4/23/11. There were 14 with ROSC and 9 without ROSC. The majority of arrests were non-VF (87%). The mean values were calculated for code duration (13 min), CCF (92%), compression depth (2.8 inches), and EtCO2 (20.3 mm Hg). Code duration was shorter (8.8 vs. 19.8 min) and CCF values higher (93.1% vs. 89.5%) in patients with ROSC. EtCO2 values were higher in VF patients with ROSC (17 vs. 11 mmHg) but not for all rhythms. In addition, terminal EtCO2 values were higher when compared to mean EtCO2 values in ROSC patients than for non-ROSC patients. Conclusion: For this small sample of inpatient cardiac arrests, patients with ROSC had shorter code durations, higher CCF values, deeper compressions, and higher terminal EtCO2 values. These data support the importance of optimal CPR in the inpatient setting.