The Importance of CO2 Capnography in Cardiac Arrest

Cardiovascular emergencies, such as cardiac arrest, require immediate attention and effective treatment to ensure optimal outcomes. One crucial aspect of resuscitation is the monitoring of chest compressions, which can be challenging due to the lack of direct visualization of the heart. This is where CO2 capnography comes in – a non-invasive technique that measures end-tidal carbon dioxide (ETCO2) levels.

In cardiac arrest, maintaining ETCO2 levels above 20 mmHg has been shown to improve survival rates. However, pediatric values are treated similarly to adult values, with the only decent review showing no increased survival rate at hospital discharge even when ETCO2 was maintained above 20 mmHg. Currently, there is limited validated work regarding pediatric resuscitation and end-ETCO2.

Waveform capnography, which measures CO2 levels in real-time, has numerous benefits and applications. For intubated patients in cardiac arrest, quantitative waveform capnography is now considered the gold standard for monitoring chest compression quality and determining return of spontaneous circulation (ROSC). When ROSC occurs, there will be a significant increase in ETCO2 levels.

High-quality chest compressions can be achieved by maintaining ETCO2 values between 10-20 mmHg. Evaluating the effectiveness of chest compressions is straightforward: low ETCO2 values (<10 mmHg) during CPR indicate that chest compression quality needs improvement.

Two practical uses of waveform capnography in CPR are evaluating chest compression effectiveness and identifying ROSC. Normal ETCO2 levels for adult patients should be between 35-45 mmHg. A decrease in perfusion will lower CO2 delivery to the lungs, resulting in a decrease in ETCO2 levels.

Capnography is an assessment tool during CPR that helps providers determine various aspects of patient status. The technology uses a sample chamber/sensor placed for optimal evaluation of expired CO2 and provides continuous, non-invasive measurement and graphical display of ETCO2 levels.

In addition to its benefits in cardiac arrest management, capnography can also be used to confirm and monitor correct endotracheal tube (ETT) placement. The American Heart Association (AHA) recommends using continuous waveform capnography along with clinical assessment for this purpose.

In conclusion, CO2 capnography is a valuable tool in cardiac arrest management, allowing providers to monitor CPR quality, optimize chest compressions, and detect ROSC during chest compressions. Its applications extend beyond cardiac arrest, including the confirmation of ETT placement. By incorporating waveform capnography into resuscitation protocols, healthcare professionals can improve patient outcomes and enhance overall care.

Co2 capnography