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Semin Respir Crit Care Med 2001; 22(1): 035-050
DOI: 10.1055/s-2001-13839
DOI: 10.1055/s-2001-13839
Selected Controversies in Cardiopulmonary Resuscitation
Steven J. White, Daniel Himes, Mazyar Rouhani, Corey M. Slovis- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Further Information
Publication History
Publication Date:
31 December 2001 (online)
ABSTRACT
Cardiopulmonary resuscitation (CPR) is performed frequently by paramedics, emergency department personnel, and inpatient physicians. Unfortunately, after more than 40 years of practice and study, there are still many controversies and unresolved treatment issues. This article focuses on four current controversies in CPR: (1) the role of end-tidal CO2 (ETCO2) detection, (2) the use of bicarbonate, (3) whether epinephrine is the optimal alpha agonist, and (4) whether amiodarone should replace lidocaine as the initial antiarrhythmic of choice in the treatment of ventricular fibrillation.
KEYWORD
Cardiac arrest - CPR - amiodarone - vasopressin - ETCO2 - capnography - ventricular fibrillation - epinephrine
REFERENCES
- 1 Ornato J P. Hemodynamic monitoring during CPB. Ann Emerg Med . 1993; 122 289-295
- 2 Cardoso M M, Banner M J, Melker R J. Portable devices used to detect endotracheal intubation during emergency situations: a review. Crit Care Med . 1998; 26 957-964
- 3 Vukmir R B, Heller M G, Stein K L. Confirmation of endotracheal tube placement: a miniaturized infrared qualitative CO2 detector. Ann Emerg Med . 1991; 20 726-729
- 4 White S J, Slovis C M. Inadvertent esophageal intubation in the field: reliance on a fool's ``gold standard''. Acad Emerg Med . 1997; 4 89-91
- 5 Birmingham P K, Cheney E W, Ward R J. Esophageal intubation: review of detection techniques. Anest Analg . 1986; 65 886-891
- 6 McGill J W, Clinton J E. Tracheal intubation. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine Philadelphia: WB Saunders; 1998
- 7 Hastings D. Airway Management Skills. In: Campbell JE, ed. Basic Trauma Life Support Textbook Englewood Cliffs, NJ: Prentiss-Hall 1995: 81-91
- 8 Schwartz D E, Matthay M A, Cohen N J. Death and other complications of emergency airway management in critically ill adults. Anesthesiology . 1995; 82 367-376
- 9 Andersen K, Hald A. Assessing the position of the tracheal tube: the reliability of different methods. Anaesthesia . 1989; 44 984-985
- 10 Knapp S, Kofer J, Stoiser B. The assessment of four different methods to verify tracheal tube placement in the critical care setting. Anesth Analg . 1999; 88 766-770
- 11 Pelucio M, Halligan L, Dhindsa H. Out-of-hospital experience with the syringe esophageal detector device. Acad Emerg Med . 1997; 4 563-568
- 12 Ornato J P, Shipley J B, Racht E M. Multicenter study of a portable, hand-size, Colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med . 1992; 21 518-523
- 13 Bhende M S, Thompson A B, Cook D R. Validity of disposable end-tidal CO2 detector in verifying endotracheal tube placement in infants and children. Ann Emerg Med . 1992; 21 142-145
- 14 MacLeod B A, Heller M B, Gerard J. Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection. Ann Emerg Med . 1991; 20 267-270
- 15 Hayden S R, Sciammarella J, Vicellio P. Colorimetric end-tidal CO2 detector for verification of endotracheal tube placement in out-of-hospital cardiac arrest. Acad EmerMed . 1995; 2 499-502
- 16 Garnett A R, Gervin C A, Gervin A S. Capnographic waveforms in esophageal intubation: effect of carbonated beverages. Ann Emerg Med . 1989; 18 387-390
- 17 Wayne M A, Slovis C M, Paraillo R G. Management of difficult airways in the field. Prehospital Emergency Care . 1999; 3 29-296
- 18 ACEP Policy Statement. Expired carbon dioxide monitoring. Ann Emerg Med . 1995; 25 441
- 19 Resolutions of the National Association of State EMS Directors: 1995. Prehospital Disaster Med . 1996; 11 240-242
- 20 Ornato J P, Garnett A R, Glauser F L. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann Emerg Med . 1990; 19 1104-1106
- 21 American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992; 268 2171-2183
- 22 Entholzner E K, Mielke L L, Breinbauer B M. End-tidal carbon dioxide during preclinical CPR: correlation with primary outcome. Am J Emerg Med . 1996; 14 109-111
- 23 Falk J L, Rackow E C, Weil M H. End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl J Med . 1988; 318 607-611
- 24 Koetter K P, Maleck W H. End-tidal carbon dioxide monitoring in cardiac arrest (letter). Acad Emerg Med . 1999; 6 88
- 25 Kellerman A L, Hackman B B, Somes G. Predicting the outcome of unsuccessful pre-hospital advanced cardiac life support. JAMA . 1993; 270 1433-1436
- 26 Bonin M J, Swor R A. Outcomes in unsuccessful field resuscitation attempts. Ann Emerg Med . 1989; 18 507-512
- 27 Gray W A, Capone R J, Moss A S. Unsuccessful emergency medical resuscitation: are continued efforts in the emergency department justified?. N Engl J Med . 1991; 325 1393-1398
- 28 Callaham M, Barton C. Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med . 1990; 18 358-362
- 29 Sanders A B, Kern K B, Otto C W. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation: a prognostic indicator for survival. JAMA . 1989; 262 1347-1351
- 30 Levine R L, Wayne M A, Miller C C. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med . 1997; 337 301-306
- 31 Ornato J P, Gonzalez E R, Garnett A R. Effect of cardiopulmonary resuscitation rate on end-tidal carbon dioxide concentration and arterial pressure in man. Crit CareMed . 1988; 16 241-245
-
32 American Heart Association. Advanced Cardiac Life Support. 1997
- 33 Levy M M. An evidence-based evaluation of the use of sodium bicarbonate during cardiopulmonary resuscitations. Crit Care Clinics . 1998; 14 457-483
- 34 Redding J S, Pearson J W. Metabolic acidosis: a factor in cardiac resuscitation. South Med J . 1967; 60 926-932
- 35 Anderson M N, Border J R, Mouritzen C V. Acidosis, catecholamines and cardiovascular dynamics: when does acidosis require correction?. Ann Surg . 1967; 166 344-356
- 36 Kirilmi B, Harris L C, Safar P. Evaluation of sodium bicarbonate and epinephrine in cardiopulmonary resuscitation. Anesth Anal . 1969; 48 649-658
- 37 Sanders A B, Kern K B, Fonken S. The role of bicarbonate and fluid loading in improving resuscitation from prolonged cardiac arrest with rapid manual chest compression CPR. Ann Emerg Med . 1990; 19 1-7
- 38 Weil M H, Rackow E C, Trevino R. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. NEJM . 1986; 315 153-156
- 39 Dybvik T, Strand T, Steen P A. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation . 1995; 29 89-95
- 40 Greenberg A. Hyperkalemia: treatment options. Seminars in Nephrology . 1998; 18 46-57
- 41 Kuvin J T. Electrocardiographic changes of hyperkalemia. NEJM . 1998; 338 662
- 42 Williams M E. Hyperkalemia. Crit Care Clin . 1991; 7 155-174
- 43 Androgue H G, Madias N E. Changes in plasma potassium concentration during acute acid base disturbances. Am J Med . 1981; 71 456-467
- 44 Kaplan J L, Braitman L E, Dalsey W C. Alkalinization is ineffective for severe hyperkalemia in nonnephrectomized dogs. Acad Emer Med . 1997; 4 93-99
- 45 Salem M M, Rosa R m, Battle D C. Extrarenal potassium tolerance in chronic renal failure: implications for the treatment of acute hyperkalemia. Am J Kidney Dis . 1991; 18 421-440
- 46 Litovotiz T L, Klein-Schwartz W, Caravatti E M. 1998 annual report of the AmericanAssociation of Poison Control Centers national data collection. Am J Emerg Med . 1999; 17 435-487
- 47 Sasyniuk B IO, Jhamandas V, Valois M. Experimental amitriptyline intoxication: treatment of cardiac toxicity with sodium bicarbonate. Ann Emerg Med . 1986; 15 1036-1039
- 48 Sharon M, Liebelt E L. Targeted management strategies for cardiovascular toxicity from tricyclic antidepressant overdose: the pivotal role for alkalinization and sodium loading.Ped Emerg Care . 1998; 14 293-298
- 49 Hedges J R, Baker P B, Tasset J J. Bicarbonate therapy for the cardiovascular toxicityof amitriptyline in an animal model. J Emerg Med . 1985; 3 254-259
- 50 Lever E, Jaspan J B. Sodium bicarbonate therapy in severe diabetic ketoacidosis. Am J Med . 1983; 75 263-268
- 51 Riley L J, Cooper M, Narins R G. Alkali therapy of diabetic ketoacidosis: biochemical, physiologic, and clinical perspectives. Diabetes Metab Rev . 1989; 5 627-636
- 52 Kaye R. Diabetic ketoacidosis: the bicarbonate controversy. J Pediatr . 1975; 87 156-159
- 53 Green S M, Rothrock S G, Ho J D, Gallant R D. Failure of adjunctive bicarbonate to improve outcome in severe diabetic ketoacidosis. Ann Emerg Med . 1998; 31 41-48
- 54 Morris L R, Murphy M B, Kitabchi A E. Bicarbonate therapy in severe diabetic ketoacidosis. Annn Intern Med . 1986; 105 836-840
- 55 Okuda Y, Adrogue H J, Field J B, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab . 1996; 81 314-320
- 56 Arieff A I, Leach W, Park R. Systemic effects of NaHCO3 in experimental lactic acidosis in dogs. Am J Physiol . 1982; 242 F586-F591
- 57 Cingolani H E, Faulkner S L, Mattiazzi A R. Depression of human myocardial contractility with ``respirator'' and ``metabolic acidosis''. Surgery . 1975; 77 427-432
- 58 Cooper D J, Walley K R, Wiggs B R. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med . 1990; 112 492-498
- 59 Mathien D, Neviere R, Billard V. Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinicalstudy. Crit Care Med . 1991; 19 1352-1356
- 60 Bjerneroth G, Sammeli O, Li Y C. Effects of alkaline buffers on cytoplasmic pH in lymphocytes. Crit Care Med . 1994; 22 1550-1556
- 61 Forsythe S M, Schmidt G A. Sodium Bicarbonate for the Treatment of Lactic Acidosis. Chest . 2000; 117 260-267
- 62 Redding J S, Pearson J W. Evaluation of drugs for cardiac resuscitation. Anesthesiology . 1963; 24 203-207
- 63 Tang W, Weil M H, Sun S, Noc M, Yang L, Gazmuri R J. Epinephrine increased the severity of postresucitation myocardial dysfunction. Circulation . 1995; 92 3089-3093
- 64 Otto C W, Yakaitis R W. The role of epinephrine in CPR: a reappraisal. Annals of Emergency Medicine . 1984; (part 2)13 84-843
- 65 Wenzel W, Linder K H, Rismer A C, Miller E A, Voelcker W G, Lingnau W. Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs. Circulation . 1999; 1379-1384
- 66 Yakaitis R W, Otto C W, Blitt C D. Relative importance of α and β adrenergic receptors during resuscitation. Crit Care Med . 1979; 7 293-296
- 67 Van Walraven C, Stiell I G, Wells G A, Hebert P C, Vandemheen K. Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest?. Ann Intern Med . 1998; 32 544-53
- 68 Weaver W D, Fahrenbruch C E, Johnson D D, Hallstrom A P, Cobb L A, Copass M K. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circ . 1990; 82 2027-2034
- 69 Roberts D, Landolfo K, Light R B, Dobson K. Early predictors of mortality for hospitalized patients suffering cardiac arrest. Chest . 1990; 97 413-419
- 70 Steill I G, Hebert P C, Weitzman B N, Wells G A, Raman S, Stark R M, Higginson L AJ, Ahuja J, Dickinson G E. High dose epinephrine on cardiac arrest. NEJM . 1992; 327 1045-1050
- 71 Callaham M, Madsen C D, Barton C W, Saunders C E, Pointer J. A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard dose epinephrine in prehospital cardiac arrest. JAMA . 1992; 268 2667-2672
- 72 Livesay J J, Follette D M, Fey K H, Nelson R L, Deland E C, Barnard R J, Buckberg G D. Optimizing myocardial supply/demand balance with α-adrenergic drugs during cardiopulmonary resuscitation. J Thorac Cardiovasc Surg . 1978; 76 244-251
- 73 Otto C W, Yakaitis R W, Blitt C D. Mechanism of action of epinephrine in resuscitation from asphyxial arrest. Crit Care Med . 1981; 9 364-365
- 74 Hoffman B B, Lefkowitz R J. Goodman and Gilmans Pharmacologic Basics of Therapeutics. New York: McGraw-Hill 1996: ch.10
- 75 Otto C W, Yakaitis R W, Redding J S, Blitt C D. Comparison of dopamine, dobutamine, and epinephrine in CPR. Crit Care Med . 1981; 9 640-643
- 76 Lindner K H, Ahnefeld F W, Bowlder I M. Comparison of epinephrine and dopamine during cardiopulmonary resuscitation. Intensive Care Medicine . 1989; 15 432-438
- 77 Redding J S, Pearson J W. Resuscitation from ventricular fibrillation. JAMA . 1968; 203 255-260
- 78 Roberts D, Landolfo K, Light R B. The effects of methoxamine and epinephrine on survival and regional distribution of cardiac output in dogs with prolonged ventricular fibrillation. Chest . 1990; 98 999-1005
- 79 Patrick W D, Freedman J, Mcewen T, Light R B, Ludwig L, Roberts D. A randomized double-blind comparison of methoxamine and epinephrine in human cardiopulmonary arrest. Am J Respir Crit Care Med . 1995; 152 519-523
- 80 Joyce S M, Barsan W G, Doan L A. Use of phenylephrine in resuscitation from asphyxial arrest. Ann Intern Med . 1983; 12 418-421
- 81 Littman L, Ashline P T, Hayes W J, Kempler P, Raymond R M, Norton J, Svenson R H, Tuntelder J R, Tatsis G P. Aminophylline fails to improve the outcome of cardiopulmonary resuscitation from prolonged ventricular fibrillation: a placebo controlled, randomized, blinded experimental study. JACC . 1994; 23 1708-1714
- 82 Burton J H, Mass M, Menegazzi J J, Yealy D M. Aminophylline as an adjunct to standard advanced cardiac life support in prolonged cardiac arrest. Ann Emerg Med . 1997; 30 154-158
- 83 Mader T J, Smithline H A, Gibson P. Aminophylline in undifferentiated out-of-hospital asystolic arrest. Resuscitation . 1999; 41 39-45
- 84 Lindner K H, Haak T, Keller A, Bothner U, Lurie K G. Release of endogenous vasopressors during and after cardiopulmonary resuscitation. Br Heart J . 1996; 75 145-150
- 85 Lindner K H, Prengel A W, Pfenninger E G, Lindner I M, Strohmeuey H, Georgieff M, Lurie K G. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation . 1995; 91 215-221
- 86 Wenzel V, Lindner K H, Prengel A W, Maier C, Voelckel W, Lurie K G, Strohmenger H U. Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med . 1999; 27 486-493
- 87 Prengel A W, Lindner K H, Keller A, Lurie K G. Cardiovascular function during the postresuscitation phase after cardiac arrest in pigs: a comparison of epinephrine versus vasopressin. Crit Care Med . 1996; 24 2014-2019
- 88 Wenzel V, Lindner K H, Krismer A C, Wolfgant G. Survival with full neurologic recovery and no cerebral pathology after prolonged cardipulmonary resuscitation with vasopressin in pigs. JACC . 2000; 35 527-533
- 89 Morris D C, Dereczyk B E, Grzybowski M, Martin G B, Rivers E P, Wortsman J, Amico J A. Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med . 1997; 4 878-883
- 90 Lindner K H, Prengel A W, Brinkmann A, Strohmenger H U, Lindner I M, Lurie K G. Vasopressin administration in refractory cardiac arrest. Ann Intern Med . 1996; 124 1061-1064
- 91 Lindner K H, Dirks B, Strohmenger H U, Prengel A W, Lindner I M, Lurie K G. Randomized comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet . 1997; 349 535-537
- 92 Slovis C M, Wrenn K D. The technique of reversing ventricular fibrillation. J Crit Illn . 1994; 9 873-879
- 93 Gonzalez E R, Kannewurf B S, Ornato J P. Intravenous amiodarone for ventricular arrhythmias: overview and clinical use. Resuscitation . 1998; 39 33-42
- 94 Eisenberg M S, Horwood B T, Cummins R O, Reynolds-Haertle R. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med . 1990; 19 115-122
- 95 Kudenchuk P J, Cobb L A, Copass M K, Cummins R O. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med . 1999; 341 871-878
- 96 Mason J W. Amiodarone. N Engl J Med . 1987; 316 455-466
- 97 Nalos P C, Ismail Y, Pappas J M, Nyitray W. Intravenous amiodarone for short-term treatment of refractory ventricular tachycardia or fibrillation. Am Heart J . 1991; 122 1629-1632
- 98 Schutzenberger W, Leisch F, Kerschner K. Clinical efficacy of intravenous amiodarone in the short-term treatment of recurrent sustained ventricular tachycardia and ventricular fibrillation. Br Heart J . 1989; 62 367-371
- 99 White R D. Antifibrillatory drugs: the case for lidocaine and procainamide. Ann Emerg Med . 1984; 13 56-58
- 100 Ware D L, Atkinson J B, Brooks M J, Echt D S. Ventricular defibrillation in canines with chronic infarction, and effects of lidocaine and procainamide. PACE . 1993; 16 337-346
- 101 Weaver W D, Fahrenbruch C E, Johnson D D, Hallstrom A P. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circulation . 1990; 82 2027-2034
- 102 Wesley R C, Resh W, Zimmerman D. Reconsiderations of the routine and preferential use of lidocaine in the emergent treatment of ventricular arrhythmias. Crit Care Med . 1991; 19 1439-1444
- 103 Harrison E E. Lidocaine in prehospital countershock refractory ventricular fibrillation. Ann Emerg Med . 1981; 10 420-423
- 104 Ryan T J, Antman E M, Brooks N H, Califf R M, Hillis L D, Hiratzka L F, Rapaport E, Riegel B, Russell R O, Smith III E E, Weaver W D. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation . 1999; 100 1016-1030
- 105 Armengol R E, Graff J, Baerman J M, Swiryn S. Lack of effectiveness of lidocaine for sustained, wide QRS complex tachycardia. Ann Emerg Med . 1989; 18 254-257
- 106 Gorgels A PM, van den Dool A, Hofs A, Mullenees R. Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Am J Cardiol . 1996; 78 43-46
- 107 Herlitz J, Ekstrom L, Wennerblom B, Axelsson A. Lidocaine in out-of-hospital ventricular fibrillation: does it improve survival?. Resuscitation . 1997; 33 199-205
- 108 Dronen S C. Antifibrillatory drugs: the case for bretylium tosylate. Ann Emerg Med . 1984; 13 805-807
- 109 Vachiery J L, Reuse C, Blecic S, Contempre B. Bretylium tosylate versus lidocaine in experimental cardiac arrest. . 1990; 8 492-495
- 110 Hanyok J J, Chow M SS, Kluger J, Fieldman A. Antifibrillatory effects of high dose bretylium and a lidocaine-bretylium combination during cardiopulmonary resuscitation. Crit Care Med . 1988; 16 691-694
- 111 Kowey P R, Levine J H, Herre J M, Pacifico A. Randomized, double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent, hemodynamically destablizing ventricular tachycardia or fibrillation. . 1995; 92 3255-3263