Capnography, King of the ABC's: A Systematic Approach for Paramedics

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There are inadequate data about the timing, duration, dosing, and choice of antiepileptic drugs for seizure prophylaxis in comatose post–cardiac arrest patients. The primary purpose of the respiratory system is to take in oxygen and give off carbon dioxide. Oxygen is necessary for cellular metabolism; it acts as the last acceptor of an electron in the electrontransport chain in mitochondria. Without oxygen, the human body metabolizes anaerobically, an unstable stage. Ifthis continues for some time, cells die. It becomes essential to monitor the levels of oxygen in cases of cardio-respiratory illnessesby measuring the amount of hemoglobin saturation by pulse oximetry. Pulse oximetry is a noninvasive means by which to monitor a person's oxygen saturation. In 3 studies, 228, 237, 239 rhythmic/periodic discharges at 48 to 72 hours after ROSC predicted poor neurological outcome from 1 month to 6 months. Specificity ranged from 66.7% to 96.1% and sensitivity ranged from 11.4% to 50.8% (certainty of evidence from low to very low).

NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. Population: Adults who are comatose after resuscitation from cardiac arrest (either in-hospital or out-of-hospital), regardless of target temperature

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Study design: Human and manikin studies were included. RCTs and nonrandomized studies (non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies) were eligible for inclusion. Unpublished studies (eg, conference abstracts, trial protocols) were excluded. In addition, gray literature (evidence not published in traditional journals) was included in this ScopRev. 19, 20 Outcome: Survival or survival with good neurological outcome at hospital discharge or longer (critical), and important outcomes of critical care length of stay, infective complications, or duration of mechanical ventilation Follow current European Society of Cardiology (ESC) guidelines for the diagnosis and management of syncope. In 3 studies, 226, 228, 237 sporadic, nonrhythmic/periodic discharges at 48 to 72 hours predicted poor neurological outcome from 1 month to 6 months. Specificity ranged from 88.9% to 97.3% and sensitivity ranging from 0.6% to 38.5% (certainty of evidence from low to very low). VCO2 is the metabolic production of CO2, VA is alveolar ventilation, VE is minute ventilation, VD is dead space ventilation, RR is the respiratory rate, and TV is tidal volume. [12]

Resuscitation team members should have the key skills and knowledge to manage a cardiac arrest including manual defibrillation, advanced airway management, intravenous access, intra-osseous access, and identification and treatment of reversible causes. The decision to limit treatment of comatose post–cardiac arrest patients should never rely on a single prognostication element. The consensus of the task force was that in patients who remain comatose in the absence of confounders (eg, sedative drugs), a multimodal approach should be used, with all supplementary tests considered in the context of the clinical examination. The most reliable combination and timing for each assessment are still to be determined and require further research.

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Minimise the risk of fire by taking off any oxygen mask or nasal cannulae and place them at least 1 m away from the patient’s chest. Ventilator circuits should remain attached. Clinicians should be cautious about potentially prolonging interruptions in chest compressions when using point-of-care echocardiography during cardiac arrest. 120, 121 Several strategies to minimize these interruptions have been proposed. 122, 123 This summary statement contains the final wording of the CoSTR statements as approved by the ILCOR task forces and by the ILCOR member councils after review and consideration of comments posted online in response to the draft 2020 CoSTRs. Within this publication, each topic includes the PICOST as well as the CoSTR, an expanded Justification and Evidence-to-Decision Framework Highlights section, and a list of knowledge gaps requiring future research studies. An evidence-to-decision table is included for each CoSTR in Appendix A in the Supplemental Materials of this publication.