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
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]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
