Monitoring during cardiac arrest: are we there yet?

Advancements in electronic data acquisition have translated into improved monitoring of victims of cardiac arrest, but initial techniques remain direct observation of pulses and respirations. The most essential monitor continues to be the electrocardiogram. However, monitoring diastolic blood pressure, myocardial perfusion pressure, and end-tidal carbon dioxide are extremely useful. Most of the current research on monitoring during cardiopulmonary resuscitation focuses on methods for analyzing ventricular fibrillation waveforms. By analyzing the waveform, defibrillation shocks may be delivered at the time when the chance of success is optimal. Low-amplitude and low-frequency fibrillation waveforms are associated with increased rates of asystole and pulseless electrical activity after defibrillation. Methods of analyzing the ventricular fibrillation waveform include measuring the amplitude and frequency and combining the contributions of amplitude and frequency by various methods to improve discrimination. Other types of monitoring being studied for their usefulness during cardiac arrests include sonography, Bispectral Index monitoring, tissue carbon dioxide monitors, and pupil observation. The test of these monitoring techniques is ultimately their ability to improve patient survival to hospital discharge, which is a major challenge for resuscitation researchers.

[1]  R. Berg,et al.  Precountershock cardiopulmonary resuscitation improves ventricular fibrillation median frequency and myocardial readiness for successful defibrillation from prolonged ventricular fibrillation: a randomized, controlled swine study. , 2002, Annals of emergency medicine.

[2]  A. Amann,et al.  The Prediction of Defibrillation Outcome Using a New Combination of Mean Frequency and Amplitude in Porcine Models of Cardiac Arrest , 2002, Anesthesia and analgesia.

[3]  A. Amann,et al.  The prediction of defibrillation outcome using a new combination of mean frequency and amplitude in porcine models of cardiac arrest. , 2002 .

[4]  R. Waalewijn,et al.  Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest. , 2002, Resuscitation.

[5]  Wanchun Tang,et al.  Predicting the success of defibrillation by electrocardiographic analysis. , 2002, Resuscitation.

[6]  Wanchun Tang,et al.  Expanding automatic external defibrillators to include automated detection of cardiac, respiratory, and cardiorespiratory arrest , 2002, Critical care medicine.

[7]  Colin A Graham,et al.  Evaluation of a new method for the carotid pulse check in cardiopulmonary resuscitation. , 2002, Resuscitation.

[8]  M. Fischler,et al.  Value of bispectral index monitoring during cardiopulmonary resuscitation. , 2002, British journal of anaesthesia.

[9]  P. Steen,et al.  The Predictive Value of Ventricular Fibrillation Electrocardiogram Signal Frequency and Amplitude Variables in Patients with Out-Of-Hospital Cardiac Arrest , 2001, Anesthesia and analgesia.

[10]  C. Otto,et al.  Cardiac arrest and monitoring. , 2001, Anesthesiology clinics of North America.

[11]  M H Weil,et al.  Optimizing timing of ventricular defibrillation , 2001, Critical care medicine.

[12]  A. Amann,et al.  The beneficial effect of basic life support on ventricular fibrillation mean frequency and coronary perfusion pressure. , 2001, Resuscitation.

[13]  W F van Gunsteren,et al.  Fibrillation power, an alternative method of ECG spectral analysis for prediction of countershock success in a porcine model of ventricular fibrillation. , 2001, Resuscitation.

[14]  H U Strohmenger,et al.  Analysing ventricular fibrillation ECG-signals and predicting defibrillation success during cardiopulmonary resuscitation employing N(alpha)-histograms. , 2001, Resuscitation.

[15]  R. O’Connor,et al.  Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes? , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[16]  Wanchun Tang,et al.  Pupil diameter and light reaction during cardiac arrest and resuscitation , 2001, Critical care medicine.

[17]  Vincent N. Mosesso,et al.  Scaling Exponent Predicts Defibrillation Success for Out-of-Hospital Ventricular Fibrillation Cardiac Arrest , 2001, Circulation.

[18]  D J Roe,et al.  Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. , 2000, The New England journal of medicine.

[19]  R. Gazmuri,et al.  Myocardial effects of repeated electrical defibrillations in the isolated fibrillating rat heart , 2000, Critical care medicine.

[20]  Wanchun Tang,et al.  Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock. , 1999, Critical care medicine.

[21]  C. Miller,et al.  End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. , 1997, The New England journal of medicine.

[22]  H U Strohmenger,et al.  Analysis of the ventricular fibrillation ECG signal amplitude and frequency parameters as predictors of countershock success in humans. , 1997, Chest.

[23]  W. Dick,et al.  Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. , 1996, Resuscitation.

[24]  R. Berg,et al.  Femoral venous pulsations during open-chest cardiac massage. , 1995, Annals of emergency medicine.

[25]  A Welz,et al.  Frequency of ventricular fibrillation as a predictor of defibrillation success during cardiac surgery. , 1994, Anesthesia and analgesia.

[26]  R F Griffith,et al.  Median frequency--a new parameter for predicting defibrillation success rate. , 1991, Annals of emergency medicine.

[27]  C W Otto,et al.  End-Tidal Carbon Dioxide Monitoring During Cardiopulmonary Resuscitation: A Prognostic Indicator for Survival , 1989 .

[28]  M. Catapano.  Effect of epinephrine on defibrillation in ischemic ventricular fibrillation , 1986 .

[29]  E. Jonas,et al.  ORIGIN OF CANINE FEMORAL PULSES DURING STANDARD CPR , 1983 .

[30]  C. Otto,et al.  Ventricular fibrillation masquerading as ventricular standstill , 1981, Critical care medicine.