ALERT Presentation: Randomized trial of

continuous capnography during

simulated arrests

International Network for Simulation-based Pediatric Innovation, Research and Education

David Kessler

Columbia University

INSPIRE @ IMSH 2014: San Francisco, California,USA

• Continuous capnography recommended during CPR to help guide therapy (2010 PALS guidelines- Class IIa LOE C)

• Clinical benefits: – ETCO2 <10 mmHg during CPR 100% sensitive for ROSC– ETCO2 during CPR increases with increased cardiac output/pulmonary blood flow– Rise in ETCO2 during CPR precedes clinical recognition of return of spontaneous circulation (ROSC)– ETCO2 post-resuscitation reflects adequacy of ventilation

• Theoretical benefits:– Guide chest compression delivery to improve effectiveness– Decreased # of pulse checks and pauses (lower no flow fraction)– Avoiding post-resuscitation over-ventilation– Earlier recognition of futile resuscitations

International Network for Simulation-based Pediatric Innovation, Research and Education

Background

• P: In-hospital resuscitation teams

• I: A. Use of continuous capnography (CC)

B. CC + education

• C: Teams with no CC monitoring available

• O: Performance on simulator – Vfib arrest

– Primary outcomes: time to recognition of inadequate chest

compression quality (depth, rate, no-flow-time fraction), time to

recognition of ROSC

– Secondary outcomes: # pulse checks, RR post-resuscitation

International Network for Simulation-based Pediatric Innovation, Research and Education

PICO Question

International Network for Simulation-based Pediatric Innovation, Research and Education

Approach / Design

I: ETCo2 feedback

C: NO EtCo2 feedback

OUTCOMES CPR quality (depth,rate,lean)No flow fraction

ED resuscitation teams:3 RN, 2 MD, 1 ERT/PA/RTPOPULATION

INTERVENTION/ COMPARISON

Asystole arrest simulated scenario

Randomization

Update

• April 2013- Applied for EMSC grant• August 2013- didn’t get it• Fall 2013- have been working on one of

the spec aims from grant (survey of ETCO2 use among EMS in 5 states)

Next steps

• Back to basic design (remove EMS spin)

• Seek other funding, internal pilot vs R18, etc.

• Any other ideas??

Name: David Kessler

Institution: Columbia

drkessler@gmail.com, 516-769-3777

Other Collaborators: Vinay Nadkarni, Melissa Langhan, Marc Auerbach, Adam Cheng, Cyril Sayhoun, Frank Overly, Linda Brown, Sandeep Gangadharan,Tensing Maa, Barbara Walsh, Dana Niles.

International Network for Simulation-based Pediatric Innovation, Research and Education

Contact Information