This document summarizes a proposed randomized trial to study the effects of continuous capnography monitoring during simulated cardiac arrests. The trial would randomize resuscitation teams to either have access to end-tidal carbon dioxide (ETCO2) feedback during simulated ventricular fibrillation arrests or not. The primary outcomes would be time to recognize inadequate chest compressions or return of spontaneous circulation. Secondary outcomes include the number of pulse checks and respiratory rate post-resuscitation. The researcher provides background on capnography during CPR and benefits found in previous studies. The proposal was not funded initially but the researcher is pursuing other funding options and revising the study design.

1. ALERT Presentation:
Randomized trial of continuous
capnography during simulated
arrests
David Kessler
Columbia University
INSPIRE @ IMSH 2014: San Francisco, California,USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background
•
•
Continuous capnography recommended during CPR to help guide therapy
(2010 PALS guidelines- Class IIa LOE C)
Clinical benefits:
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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:
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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

3. PICO Question
• 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

4. Approach / Design
POPULATION
ED resuscitation teams:
3 RN, 2 MD, 1 ERT/PA/RT
Randomization
Asystole arrest simulated scenario
INTERVENTION
/ COMPARISON
OUTCOMES
I: ETCo2
feedback
C: NO EtCo2
feedback
CPR quality (depth,rate,lean)
No flow fraction
International Network for Simulation-based Pediatric Innovation, Research and Education

5. 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)

6. Next steps
• Back to basic design (remove EMS
spin)
• Seek other funding, internal pilot vs
R18, etc.
• Any other ideas??

7. Contact Information
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