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1. Use of a Cardiopulmonary Resuscitation Video to Assist Intensive Care Unit Resident Physicians during Code Status Discussions

Author

Trinh T. Pham, Israel Acosta Sanchez, Salil Kalra, Sarung Kashyap, June Mbae, Natalie Marie Punal, Maria Panlilio, Daren Heyland, and Tirsa M. Ferrer Marrero

Subjects
code status discussions, CPR video, intensive care unit, resident physicians, Medicine (General), R5-920
Abstract

Background: Code status discussions (CSDs) in the intensive care unit (ICU) are frequently conducted by resident physicians. Cardiopulmonary resuscitation (CPR) videos when used to aid ICU patients and families in code status decision making have been shown to have a positive impact. The purpose of this study is to evaluate the impact of a CPR video, when made available to supplement trainee?patient CSDs, on ICU residents' comfort level when conducting these discussions. Objectives: To assess whether a CPR video as an intervention tool would increase residents' comfort level when conducting CSDs. Methods: This is a pre- and postintervention pilot study. A presurvey querying details about trainees' comfort level when conducting CSDs was administered to the residents at the beginning of the ICU rotation, and a CPR video was availed to them to supplement their trainee?patient CSDs. A postsurvey was administered to trainees at the end of their ICU rotation to evaluate and analyze the impact of the CPR video on residents' comfort level when conducting trainee?patient CSDs. Results: A total of 118 trainees rotated through the ICU with 43 (36%) answering the presurvey and 28 (24%) answering the postsurvey. Twenty-two (51%) presurvey respondents felt extremely comfortable and 18 (42%) felt somewhat comfortable conducting CSDs. Thirteen (46%) postsurvey respondents felt extremely comfortable and 12 (43%) felt somewhat comfortable conducting CSDs. Most postsurvey respondents (79%) almost never used the video and (67%) neither agree nor disagree that the video was useful. Conclusion: In our small cohort, CPR video when made available to supplement trainee?patient CSDs did not impact resident physicians' comfort level when conducting these discussions. The residents' low level of engagement with this video, among other factors, could explain our results.

Published
2022
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2. A Pilot Study of End-Tidal Carbon Dioxide in Prediction of Inhospital Cardiac Arrests

Author

Kevin J He, Maria Panlilio-Villanueva, Dustin R. Fraidenburg, Tianxiu Wang, James Chang, Scott T. Benken, and Jeffrey J. Mucksavage

Subjects
medicine.medical_specialty, business.industry, Advanced cardiac life support, Observational Study, Retrospective cohort study, General Medicine, Odds ratio, Return of spontaneous circulation, end-tidal carbon dioxide, Logistic regression, medicine.disease, Intensive care unit, intensive care unit, law.invention, critical care, law, Internal medicine, cardiology, Cohort, Pulseless electrical activity, medicine, Cardiology, inhospital cardiac arrest, business
Abstract

Objectives: A validated means to predict inhospital cardiac arrest is lacking. The purpose of this study was to evaluate the changes in end-tidal carbon dioxide, as it correlates with the progression to inhospital cardiac arrest in ICU patients. Design, Setting, and Patients: Single-center, retrospective cohort study of mechanically ventilated ICU patients (age > 18 yr old) having inhospital cardiac arrest with advanced cardiac life support and continuous end-tidal carbon dioxide monitoring at a single academic center from 2014 to 2017. Demographics, clinical variables, and outcomes were collected. End-tidal carbon dioxide was collected from 5 to 2,880 minutes before inhospital cardiac arrest. Data were analyzed using descriptive statistics, and model estimates were generated using a repeated-measures categorical model with restricted maximum likelihood estimation and fully specified (autoregressive) covariance to assess the effect of time on changes in end-tidal carbon dioxide. Measurements and Main Results: A total of 788 patients were identified and 104 met inclusion criteria, where 62% were male with an average age of 58.5 years. Seventy-four percent required vasopressors and 72% experienced pulseless electrical activity. Mean end-tidal carbon dioxide 5 minutes prior to inhospital cardiac arrest was significantly lower than all evaluated time points except 180 minutes (p < 0.05). One patient survived to hospital discharge. In multivariate logistic regression modeling for return of spontaneous circulation, a greater change in the prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum was associated with a decreased likelihood of return of spontaneous circulation (odds ratio 0.903; 95% CI, 0.832–0.979; p = 0.014). Additionally, a change from prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum greater than 17 mm Hg was associated with a decreased likelihood of return of spontaneous circulation and odds ratio 0.150; 95% CI, 0.036–0.66; p = 0.012). Conclusions: Mean end-tidal carbon dioxide is significantly lower immediately before inhospital cardiac arrest. The statistical and clinical significance of end-tidal carbon dioxide may highlight its utility for predicting inhospital cardiac arrest in ICU patients. Comparison analysis and modeling explorations in a larger cohort are needed.

Published
2020

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