Correlation of EEG-based brain resuscitation index and end-tidal carbon dioxide in porcine cardiac arrest model

Abstract

Evaluation and monitoring perfusion of vital organs is important during resuscitation from cardiac arrest. We developed a non-invasive electroencephalogram (EEG) based brain resuscitation index (EBRI) as a physiologic indicator measuring organ perfusion during cardiopulmonary resuscitation (CPR) and evaluated the correlation of EBRI and end-tidal carbon dioxide (ETCO2). A randomized crossover experimental study using a porcine cardiac arrest model was designed. After 1 minute of untreated ventricular fibrillation, 10 periods of higher-quality CPR (compression depth 5 cm and compression rate 100/min) for 50 seconds and lower-quality CPR (compression depth 3 cm and compression rate 60/min) for 50 seconds were performed in alternation. EBRI was calculated from the single EEG channel with the lowest noise. Mixed-model analysis was conducted to compare the differences of hemodynamic parameters, ETCO2, and EBRI between higher-quality CPR periods and lower-quality CPR periods. Pearson’s correlation coefficient was calculated to assess correlation between EBRI and ETCO2. The experiment was performed on 5 female swine (44.6 ± 2.8 kg). Higher-quality CPR showed significantly higher delta EBRI (median [IQR] 0.1 [0.0–0.2]) than did lower-quality CPR (median [IQR] –0.1 [–0.2–0.0], p < 0.01). EBRI had a statistically moderate positive correlation with ETCO2 (r = 0.51). In this porcine cardiac arrest model, EBRI was successfully obtained during resuscitation and had a statistically moderate correlation with ETCO2.