Abstract
Background
Clinical guidelines for adult out-of-hospital cardiac arrest (OHCA) recommend a ventilation
rate of 8–10 per minute yet acknowledge that few data exist to guide recommendations.
The goal of this study was to evaluate the utility of continuous capnography to measure
ventilation rates and the association with return of spontaneous circulation (ROSC).
Methods
This was a retrospective observational cohort study. We included all OHCA during a
two-year period and excluded traumatic and pediatric patients. Ventilations were recorded
using non-invasive continuous capnography. Blinded medically trained team members
manually annotated all ventilations. Four techniques were used to analyze ventilation
rate. The primary outcome was sustained prehospital ROSC. Secondary outcomes were
vital status at the end of prehospital care and survival to hospital admission. Univariable
and multivariable logistic regression models were constructed.
Results
A total of 790 OHCA were analyzed. Only 386 (49%) had useable capnography data. After
applying inclusion and exclusion criteria, the final study cohort was 314 patients.
The median ventilation rate per minute was 7 (IQR 5.4–8.5). Only 70 (22%) received
a guideline-compliant ventilation rate of 8–10 per minute. Sixty-two (20%) achieved
the primary outcome. No statistically significant associations were observed between
any of the ventilation parameters and patient outcomes in both univariable and multivariable
logistic regression models.
Conclusions
We failed to detect an association between intra-arrest ventilation rates measured
by continuous capnography and proximal patient outcomes after OHCA. Capnography has
poor reliability as a measure of ventilation rate. Achieving guideline-compliant ventilation
rates remains challenging.
Keywords
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 29,
2022
Received in revised form:
November 28,
2022
Received:
September 13,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
