Use of end-tidal carbon dioxide to predict outcome in prehospital cardiac arrest

End-tidal CO2 pressure determinants during hemorrhagic shock

“…Using this relationship, investigators have demonstrated that PETCO 2 effectively tracks hemodynamic changes in experimental and clinical settings of no-flow or low-flow conditions [2,3,4,5,6,7,8,9,10,11,12,13]. For example, during cardiac arrest PETCO 2 falls close to zero [5,6,7,8,9,10,11,12]. When cardiopulmonary resuscitation starts, PETCO 2 increases and is correlated to pulmonary blood flow [5,6,7].…”

Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication: A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke (Part II)

“…Lack of adherence to established CPR guidelines (Abella et al, 2005a;Ko et al, 2004;Wik et al, 2005), including failure to deliver a shock or achieve ROSC before transport (Morrison et al, 2006), and long preshock pauses with extended interruption to assess rhythms and provide ventilation have been associated with poor outcome (Abella et al, 2005a;Wik et al, 2005). A maximum end-tidal carbon dioxide (ETCO 2 ) of <10 mm Hg (as a marker of cardiac output during CPR) is associated with worse outcomes (Ahrens et al, 2001;Cantineau et al, 1996;Grmec and Klemen, 2001;Grmec and Kupnik, 2003;Levine et al, 1997;Wayne et al, 1995). Other arrest-related factors associated with poor outcome that are unreliable as predictors are asystole as the initial cardiac rhythm (Pepe et al, 1993;Wright et al, 1990) and noncardiac causes of arrest (Rogove et al, 1995;Van Hoeyweghen et al, 1989).…”

A Review of Carbon Dioxide Monitoring During Adult Cardiopulmonary Resuscitation

“…In another prospective observational study, an ETCO 2 level of 10 mmHg or less accurately predicted death in victims with pulseless electrical activity, with sensitivity, specificity, positive and negative predictive value being 100% [48]. Similarly, Wayne et al suggested the rule of 10 mmHg in capnometry during CPR; a final ETCO 2 value of less than 10 mmHg is associated with a very low possibility of ROSC [44]. Another study of 246 out-of-hospital cardiac arrest victims reported that initial and final ETCO 2 values of less than 10 mmHg were incompatible with survival [12].…”

“…An abrupt increase in ETCO 2 , under constant ventilation and CO 2 production, provides the fastest indication of ROSC [41][42][43], while ETCO 2 changes may precede a palpable pulse [44,45], which is very important especially when invasive monitoring is not available [46].…”