A Sudden Increase in Partial Pressure End-Tidal Carbon Dioxide (PETCO2) at the Moment of Return of Spontaneous Circulation

Part 8: Adult Advanced Cardiovascular Life Support

“…This may be avoided by using physiologic monitoring such as quantitative waveform capnography, intra-arterial pressure monitoring, and continuous central venous oxygen saturation monitoring to detect ROSC during chest compressions. 93,[167][168][169][170][171][172][173][174][175][176][177] However, adding an additional pause for rhythm and pulse check after shock delivery but before vasopressor therapy will decrease myocardial perfusion during the critical postshock period and could reduce the chance of achieving ROSC.…”

Part 14: Pediatric Advanced Life Support

“…53,[163][164][165][166][167][168][169] If the PETCO 2 is consistently Ͻ10 to 15 mm Hg, focus efforts on improving chest compressions and make sure that the victim does not receive excessive ventilation. An abrupt and sustained rise in PETCO 2 in adults 170,171 and animals 110 is observed just prior to clinical identification of ROSC, so use of PETCO 2 may spare the rescuer from interrupting chest compressions for a pulse check. PETCO 2 must be interpreted with caution for 1 to 2 minutes after administration of epinephrine or other vasoconstrictive medications because these medications may decrease the end-tidal CO 2 level by reducing pulmonary blood flow.…”

Management of Cardiac Arrest in Pregnancy

“…Capnography indirectly measures cardiac output in an intubated patient with stable ventilation [13] . During resuscitation, rising end-tidal CO 2 levels or sustained levels above 10 mmHg suggest adequacy of chest compressions and may be predictive of ROSC [14][15][16][17][18] . Use of continuous capnography if not readily available, should neither result in interruption of high-quality chest compressions nor delay perimortem delivery in the event of no ROSC.…”