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CPR capnography: It’s not where you’ve been, but where you’re going

  • James H. Paxton
    Correspondence
    Corresponding author at: Department of Emergency Medicine, Wayne State University School of Medicine, University Health Center, Suite #6G, 4201 St Antoine St, Detroit, MI 48201, USA.
    Affiliations
    Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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  • Brian J. O'Neil
    Affiliations
    Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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      Expired end-tidal carbon dioxide (ETCO2) capnography has been posited as a reliable non-invasive marker of the adequacy of cardiopulmonary resuscitation (CPR) since the mid-1980s.
      • Sanders A.B.
      • Atlas M.
      • Ewy G.A.
      • et al.
      Expired PCO2 as an index of coronary perfusion pressure.
      The prevailing theory is that adequate cardiac output generated by high-quality external chest compressions should produce ETCO2 levels approaching normal physiologic values, assuming no other impairments to gas exchange. In the setting of high-quality CPR, persistently low ETCO2 levels have been shown to be associated with poor survival, while higher ETCO2 levels (particularly if increasing during CPR) correlate with increased likelihood of return of spontaneous circulation (ROSC) and survival to hospital discharge.
      • Savastano S.
      • Baldi E.
      • Raimondi M.
      • et al.
      End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest.
      • Levine R.L.
      • Wayne M.A.
      • Miller C.C.
      End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest.
      • Grmec S.
      • Klemen P.
      Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?.
      • Touma O.
      • Davies M.
      The prognostic value of end tidal carbon dioxide during cardiac arrest: a systematic review.
      • Crickmer M.
      • Drennan I.R.
      • Turner L.
      • et al.
      The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity.
      • Gutiérrez J.J.
      • Leturiondo M.
      • DeGauna S.R.
      • et al.
      Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation.
      Despite mounting evidence of the importance of ETCO2 monitoring during CPR, reliable ETCO2-based prognostication of survival to hospital discharge with favorable neurologic outcome remains elusive.
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