A novel capnogram analysis to guide ventilation during continuous chest compressions resuscitation. From clinical to experimental observations
Bibliographic record
Abstract
Abstract Background: Cardio-Pulmonary Resuscitation (CPR) decreases lung volume below the functional residual capacity and can generate intrathoracic airway closure. Conversely, large insufflations can induce thoracic distension and jeopardize circulation. The capnogram (CO2 signal) obtained during continuous chest compressions can reflect intrathoracic airway closure and we hypothesized here that it can also indicate thoracic distension. Objectives: to test whether a specific capnogram may identify thoracic distension during CPR and assess its impact on gas exchange and hemodynamics. Methods: 1. In out-of-hospital cardiac arrest patients, we identified on capnograms three patterns: intrathoracic airway closure, thoracic distension or regular pattern. An algorithm was designed to identify them automatically.2. To link CO2 patterns with ventilation, we conducted three experiments:i) Reproducing the CO2 patterns in human cadavers. ii) Assessing the influence of tidal volume and respiratory mechanics on thoracic distension using a mechanical lung model. iii) Exploring the impact of thoracic distension patterns on different circulation parameters during CPR on a pig model. Measurements and main results: Clinical data: 202 patients were included. Intrathoracic airway closure was present in 35%, thoracic distension in 22% and regular pattern in 43%. Experiments:i) Higher insufflated volumes reproduced thoracic distension CO2 patterns in 5 cadavers. ii) In the mechanical lung model, thoracic distension patterns were associated with higher volumes and longer time constants. iii) In six pigs during CPR with various tidal volumes, a CO2 pattern of thoracic distension, but not tidal volume per se, was associated with a significant decrease in blood pressure and cerebral perfusion. Conclusions: During CPR, intrathoracic airway closure, thoracic distension or regular pattern can be identified by capnogram analysis. A thoracic distension pattern on the capnogram may indicate a negative impact of ventilation on blood pressure and cerebral perfusion during CPR, not predicted by tidal volume per se.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".