Dr. David Kessler (Columbia U)

1. ALERT Presentation:
Randomized trial of continuous
capnography during simulated arrests
David Kessler
Columbia University
IMSH 2013: Orlando, Florida / USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background
• Continuous capnography recommended during CPR to help guide therapy
(2010 PALS guidelines- Class IIa LOE C)
• Proven benefits:
– rise in petco2 precedes clinical recognition of return of spontaneous circulation (ROSC)
– 100% sensitive for ROSC
• Theoretical benefits:
– Improved compressions
– Decreased # of pulse checks and pauses (lower no flow fraction)
– Avoiding excessive ventilation
– Earlier recognition of futile resuscitations
International Network for Simulation-based Pediatric Innovation, Research and Education

3. PICO Question
• 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 ROSC,no-flow-time
fraction, compression quality (depth, ETco2 amount, speed)
– Secondary outcomes: timing/# of epinephrine & defibs, # pulse
checks, RR
International Network for Simulation-based Pediatric Innovation, Research and Education

4. Approach / Design
Outcomes: Outcomes:
ETCo2 Time to ROSC Time to ROSC
CPR quality CPR quality
No flow fraction No flow fraction
(RETENTION)
ETCo2+education
Control
Randomization Simulation 1 Simulation 2
Time = 0 Time = 3 months
International Network for Simulation-based Pediatric Innovation, Research and Education

5. 3 Questions to improve study
1. Should we consider other populations (prehospital
setting, residents, etc?). Is focus on team or
individual (e.g. leader)
2. What simulator would be best?
3. What/who should be the the focus of the education?
4. What other method of assessment should I use
International Network for Simulation-based Pediatric Innovation, Research and Education

6. Contact Information
Name: David Kessler
Institution: Columbia
E-mail, Phone: drkessler@gmail.com,
516-769-3777
Other Collaborators: Melissa Langhan
International Network for Simulation-based Pediatric Innovation, Research and Education