A Review of Carbon Dioxide Monitoring During Adult Cardiopulmonary Resuscitation

Abstract

Although high quality cardiopulmonary resuscitation is one of the most significant factors related to favourable outcome, its quality depends on many components, such as airway management, compression depth and chest recoil, hands-off time, and early defibrillation. The most common way of controlling the resuscitation efforts is monitoring of end-tidal carbon dioxide. The International Liaison Committee on Resuscitation suggests this method both for in-hospital and out-of-hospital cardiac arrest. However, despite the abundant human and animal studies supporting the usefulness of end-tidal carbon dioxide, its optimal values during cardiopulmonary resuscitation remain controversial. In this review, the advantages and effectiveness of end-tidal carbon dioxide during cardiopulmonary resuscitation are discussed and specific target values are suggested based on the available literature.

Evaluation of end‐tidal carbon dioxide as a predictor of return of spontaneous circulation in dogs and cats undergoing cardiopulmonary resuscitation

“…In addition to mechanical problems, other reported limitations of capnometry during CPR include transient increases in PetCO 2 after administration of sodium bicarbonate, and decreases after administration of vasopressors including epinephrine . Because no patient in our study received sodium bicarbonate, and almost every patient in our study received epinephrine, these medications were unlikely to affect our results.…”

“…In the human hospital and prehospital settings, PetCO 2 is frequently used as an indicator of effectiveness of chest compressions and has been shown to correlate well with cardiac output and coronary perfusion pressure . However, metabolism, circulation, and minute alveolar ventilation all influence its measurement, and all likely play roles in the mechanism by which PetCO 2 is linked with ROSC . Therefore, it is likely that the measured value in patients with CPA is multifactorial and also represents ongoing tissue metabolism as well as ventilation parameters .…”

Near‐infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta‐analysis

“…The diastolic pressure could help us estimate CPP, but it also requires invasive monitoring. End‐tidal capnography (ETCO 2 ) is a well‐accepted surrogate marker for cardiac output and CPP and as an immediate prognostic tool during CA . However, many confounding factors can alter ETCO 2 and its prognosticating ability .…”

BET 1: Can the value of end tidal CO2prognosticate ROSC in patients coming into emergency department with an out-of-hospital cardiac arrest (OOHCA)?

“…(3) No clear indication or suggestion of what ETCO 2 level can be used to prognosticate ROSC—however, does give an indication of when best to assess this. (4) Published in a low impact medical journalDuring the CPR, the most reliable time for ROSC estimation according to PetCO 2 values is 20th minIn distinguishing ROSC and Exitus, ETCO 2 measurements within 5–20 min intervals showed highest performance on the 20th (area below the ROC curve was determined to be 0.850 (95% CI 0.721 to 0.980)) and lowest on the 5th minute (area below the ROC curve was determined to be 0.730 (95% CI 0.610 to 0.849))None of the patients who had ETCO 2 levels less than 14 mm Hg survivedPantazopoulos  et al ,  2015,4 Greece42 studies included in qualitative synthesisNarrative reviewAlthough changes and trends in ETCO 2 values during CPR are more important than absolute ETCO 2 levels, current data suggest that certain cut-off values may be targeted; an ETCO 2  >10 mm Hg is correlated with increased possibility for ROSCNo systematic review or meta-analysis doneRescuers should target a 20 min ETCO 2 of at least 20 mm HgThe value of a trend more than absolute ETCO 2 values may be most important in the presence of a treatable causeAn abrupt increase in ETCO 2 , under constant ventilation and CO 2 production, provides the fastest indication of ROSCCPR, cardiopulmonary resuscitation; EtCO 2 , end tidal CO 2 ; PetCO 2 , end tidal CO 2 tension; ROSC, return of spontaneous circulation. …”