Adjuncts to CPR
Adjuncts to CPR
Cricoid Pressure
Cricoid pressure is an intervention whereby the rescuer applies pressure on the patient’s cricoid cartilage. The goal is to push the trachea against the esophagus to prevent aspiration of gastric contents or improve visualization of the vocal cords during ET tube insertion.
However, the AHA no longer recommends using cricoid pressure since it can delay or prevent the placement of an advanced airway. Also, some studies have shown that it is not effective in preventing aspiration.
Monitoring Physiologic Parameters During CPR
Physiologic metrics such as waveform capnography, arterial relaxation diastolic pressure, arterial pressure monitoring, and central venous oxygen saturation can guide the responder in performing CPR, administering vasopressor therapy, and detecting signs of ROSC.
Threshold values were set based on ROSC results with CPR, and studies have shown that a sudden increase in these measurements is a good indication of ROSC.60,61 The advantage of these metrics is that they can provide actionable measurements without interrupting chest compressions.
Ultrasound During Cardiac Arrest
Myocardial contractions can be assessed at the bedside by 2-D echocardiogram after achieving ROSC. Bedside ultrasonography can identify possible reversible causes of cardiac arrest, such as hypovolemia, pneumothorax, pulmonary thromboembolism, or pericardial tamponade.
A qualified sonographer can use ultrasound to evaluate the heart or other structures during cardiac arrest if it does not interrupt resuscitation protocols.
Ultrasound allows the practitioner to assess cardiac contractility.
Ultrasound allows the practitioner to assess cardiac contractility.
Key Takeaway
If the ECG monitor shows an organized rhythm, but the ultrasound shows no movement of the heart, the patient is in PEA.
End-Tidal Carbon Dioxide Monitoring for Predicting Failed Resuscitation
In cardiac arrest patients who are intubated, the waveform capnography readings can be predictive.
If, after 20 minutes of resuscitation, the ETCO2 remains < 10 mm Hg and does not improve, it may signify an extremely poor chance of achieving ROSC and survival. When making the determination to halt resuscitative efforts, this data can be considered in combination with the clinical condition and other parameters.
Sudden Rise in End-Tidal CO2 Indicates ROSC
Extracorporeal CPR
Some studies have reported improved survival with a good neurologic outcome when using ECMO to resuscitate cardiac arrest patients. However, the treatment is limited to specific situations when there is a potential for illness reversal or imminent cardiac transplant because of its high cost and resource-intense requirements.
If a facility is well equipped to provide extracorporeal CPR, then it is a viable treatment option in certain situations, including cardiac arrest.62 The facility will have an established protocol and parameters for use.
ECMO Illustration
Extracorporeal Membrane Oxygenation System63
An ECMO machine displays color difference of circulating blood.
Related Video: ECMO Explained – What is It and How It Works
60 Sheak KR, Wiebe DJ, Leary M, et al. Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest. Resuscitation. 2015;89:149–154.
61 Gutiérrez JJ, Ruiz JM, Ruiz de Gauna S, et al. Modeling the impact of ventilations on the capnogram in out-of-hospital cardiac arrest. PLoS One. 2020;15(2):e0228395
62 Pappalardo F, Montisci A. What is extracorporeal cardiopulmonary resuscitation? J Thorac Dis. 2017;9(6):1415–1419.
63 Sweeny B. Extracorporeal membrane oxygenation (ECMO) in the ED. EmDOCs.net website.
www.emdocs.net/extracorporeal-membrane-oxygenation-ecmo-in-the-ed/ (CC-BY-4.0)