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Capnography during cardiopulmonary resuscitation: Current evidence and future directions.

Kodali BS, Urman RD - J Emerg Trauma Shock (2014)

Bottom Line: Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports.Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC).There is emerging evidence that PETCO2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

ABSTRACT
Capnography continues to be an important tool in measuring expired carbon dioxide (CO2). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC). Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA). There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

No MeSH data available.


Related in: MedlinePlus

A sidestream capnograph with CO2 display showing waveforms (solid arrows) and end-tidal CO2 value (dashed arrow)
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Figure 2: A sidestream capnograph with CO2 display showing waveforms (solid arrows) and end-tidal CO2 value (dashed arrow)

Mentions: Sidestream capnography is the most widely used method for continuous CO2 monitoring [Figure 1].[3] It involves the use of disposable tubing (usually several feet long) and a T-piece adapter, which is inserted between the breathing circuit and endotracheal tube or other airway device. The tubing is connected from the side port on the adapter to a separate unit which contains the CO2 sensor, and a sample of gas is aspirated through this disposable tubing during the respiratory cycle into the capnograph for measurement. Because this gas sample must travel through the tubing to the CO2 sensor before it is processed, there is a slight delay in the display of the CO2 waveform. One of the main advantages of sidestream capnography is that it can be used in nonintubated patients. For example, there are modified nasal cannulas which allow the sampling of expired gases even while administering supplemental oxygen. A drawback of sidestream capnography is that the tubing may become blocked from water vapor or secretions. The use of a filter between the tubing and the unit containing the CO2 sensor minimizes this problem. Keeping the sample tubing antigravity can also minimize contamination from water vapor or secretions. A sidestream capnograph with a display of waveforms and end-tidal CO2 (ETCO2) values is shown in Figure 2.


Capnography during cardiopulmonary resuscitation: Current evidence and future directions.

Kodali BS, Urman RD - J Emerg Trauma Shock (2014)

A sidestream capnograph with CO2 display showing waveforms (solid arrows) and end-tidal CO2 value (dashed arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231274&req=5

Figure 2: A sidestream capnograph with CO2 display showing waveforms (solid arrows) and end-tidal CO2 value (dashed arrow)
Mentions: Sidestream capnography is the most widely used method for continuous CO2 monitoring [Figure 1].[3] It involves the use of disposable tubing (usually several feet long) and a T-piece adapter, which is inserted between the breathing circuit and endotracheal tube or other airway device. The tubing is connected from the side port on the adapter to a separate unit which contains the CO2 sensor, and a sample of gas is aspirated through this disposable tubing during the respiratory cycle into the capnograph for measurement. Because this gas sample must travel through the tubing to the CO2 sensor before it is processed, there is a slight delay in the display of the CO2 waveform. One of the main advantages of sidestream capnography is that it can be used in nonintubated patients. For example, there are modified nasal cannulas which allow the sampling of expired gases even while administering supplemental oxygen. A drawback of sidestream capnography is that the tubing may become blocked from water vapor or secretions. The use of a filter between the tubing and the unit containing the CO2 sensor minimizes this problem. Keeping the sample tubing antigravity can also minimize contamination from water vapor or secretions. A sidestream capnograph with a display of waveforms and end-tidal CO2 (ETCO2) values is shown in Figure 2.

Bottom Line: Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports.Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC).There is emerging evidence that PETCO2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

ABSTRACT
Capnography continues to be an important tool in measuring expired carbon dioxide (CO2). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC). Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA). There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

No MeSH data available.


Related in: MedlinePlus