Capnography in Cardiac Arrest

OVERVIEW

  • Current ILCOR guidelines advise that capnography is useful during cardiac arrest resuscitation
  • ETCO2 can be used as a surrogate marker of cardiac output

USES

Uses during cardiac arrest:

  • gradual fall in ETCO2 suggests compressionist fatigue during CPR -> time to change compressionists
  • abrupt increase in ETCO2 suggests ROSC during CPR (detectable before pulse check)
  • ETCO2 at 20 minutes of CPR is prognostically useful

Prognosis

  • >20 mmHg at 20 minutes CPR -> higher chance of ROSC
  • <10 mmHg at 20 minutes CPR -> almost no chance of ROSC

CONFOUNDERS

Confounders include:

  • respiratory causes of arrest
  • PE
  • disconnection of BVM/ ventilator
  • disconnection or obstruction of capnograph detector
  • dislodgement or malposition of endotracheal tube
  • bystander CPR

VIDEO

Jon Schonert’s PK SMACC-talk on Capnography in Cardiac Arrest

References and Links

  • Heradstveit BE, Sunde K, Sunde GA, Wentzel-Larsen T, Heltne JK. Factors complicating interpretation of capnography during advanced life support in cardiac arrest–a clinical retrospective study in 575 patients. Resuscitation. 2012 Jul;83(7):813-8. PMID: 22370007.
  • Kolar M, Krizmaric M, Klemen P, Grmec S. Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field: a prospective observational study. Crit Care. 2008;12(5):R115. PMC2592743.
  • Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997 Jul 31;337(5):301-6. PMID: 9233867. [Free Full Text]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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