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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

Return of spontaneous circulation is indicated by an abrupt and sustained increase in the height of capnogram
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Figure 5: Return of spontaneous circulation is indicated by an abrupt and sustained increase in the height of capnogram

Mentions: During the administration of anesthesia, there is a good correlation between PETCO2 values and cardiac index.[67] Several studies showed that this relationship between cardiac output and PETCO2 values is also valid during CPR.[89101112] This principle formed the basis for the induction of capnography into current ACLS guidelines.[1] In a study by Jin et al., hemorrhagic shock was induced in five pigs by bleeding them followed by reinfusion of shed blood.[8] End-tidal CO2 values were measured throughout this process. The authors determined that there was good correlation between cardiac output and PETCO2 values during hemorrhage and reinfusion. Shibutani et al., replicated these results in patients undergoing aortic aneurysm surgery.[7] The authors demonstrated a significant correlation between the percent decreases of PETCO2 versus the percent decreases in cardiac output in patients with constant ventilation.[7] Two mechanisms have been postulated to explain this relationship: firstly, decreased delivery of CO2 to the lung and, secondly, increase in the alveolar dead space consequent to relatively high ventilation to perfusion rate, resulting in high ventilation/perfusion ratio. Both of these factors can result in the overall decrease in CO2 output from the lungs during decreased cardiac output states. The correlation between PETCO2 and cardiac output has two important implications during CPR. First, the effectiveness of CPR in producing adequate cardiac output can be monitored based on the PETCO2 values. Secondly, abrupt increases in PETCO2 values suggest concomitant increases in cardiac output and are indicative of the return of spontaneous circulation (ROSC) as shown in Figure 5.


Capnography during cardiopulmonary resuscitation: Current evidence and future directions.

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

Return of spontaneous circulation is indicated by an abrupt and sustained increase in the height of capnogram
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Return of spontaneous circulation is indicated by an abrupt and sustained increase in the height of capnogram
Mentions: During the administration of anesthesia, there is a good correlation between PETCO2 values and cardiac index.[67] Several studies showed that this relationship between cardiac output and PETCO2 values is also valid during CPR.[89101112] This principle formed the basis for the induction of capnography into current ACLS guidelines.[1] In a study by Jin et al., hemorrhagic shock was induced in five pigs by bleeding them followed by reinfusion of shed blood.[8] End-tidal CO2 values were measured throughout this process. The authors determined that there was good correlation between cardiac output and PETCO2 values during hemorrhage and reinfusion. Shibutani et al., replicated these results in patients undergoing aortic aneurysm surgery.[7] The authors demonstrated a significant correlation between the percent decreases of PETCO2 versus the percent decreases in cardiac output in patients with constant ventilation.[7] Two mechanisms have been postulated to explain this relationship: firstly, decreased delivery of CO2 to the lung and, secondly, increase in the alveolar dead space consequent to relatively high ventilation to perfusion rate, resulting in high ventilation/perfusion ratio. Both of these factors can result in the overall decrease in CO2 output from the lungs during decreased cardiac output states. The correlation between PETCO2 and cardiac output has two important implications during CPR. First, the effectiveness of CPR in producing adequate cardiac output can be monitored based on the PETCO2 values. Secondly, abrupt increases in PETCO2 values suggest concomitant increases in cardiac output and are indicative of the return of spontaneous circulation (ROSC) as shown in Figure 5.

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