Alert 2014-progress-kessler
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Transcript of Alert 2014-progress-kessler
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
[email protected], 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