Effect of End-Tidal Carbon Dioxide Measurement on Resuscitation Efficiency and Termination of Resuscitation

Faruk OZTURK; Ismet PARLAK; Sadiye YOLCU; Onder TOMRUK; Bulent ERDUR; Rifat KILICASLAN; Ali Savas MIRAN; Serhat AKAY

doi:10.5505/1304.7361.2014.65807

Faruk OZTURK¹, Ismet PARLAK¹, Sadiye YOLCU², Onder TOMRUK³, Bulent ERDUR⁴, Rifat KILICASLAN¹, Ali Savas MIRAN¹, Serhat AKAY¹

¹Department of Emergency Medicine, Bozyaka Training and Research Hospital, Izmir
²Department of Emergency Medicine, Bozok University Faculty of Medicine, Yozgat
³Department of Emergency Medicine, Suleyman Demirel University Faculty of Medicine, Isparta
⁴Department of Emergency Medicine, Pamukkale University Faculty of Medicine, Denizli

Keywords: Capnography; capnometry; cardiopulmonary arrest; resuscitation

Abstract

Objectives

In this study, the value of end-tidal carbon dioxide (ETCO₂) levels measured by capnometry were evaluated as indicators of resuscitation effectiveness and survival in patients presenting to the emergency department with cardiopulmonary arrest.

Methods

ETCO₂ was measured after 2 minutes of compression or 150 compressions. ETCO₂ values were measured in patients that were intubated and in those who underwent chest compression. The following parameters were recorded for each patient: demographic data, chronic illness, respiration type, pre-hospital CPR, arrest rhythm, arterial blood gas measurements, ETCO₂ values with an interval of 5 minutes between the measurement and the estimated time of arrest, time to return to spontaneous circulation.

Results

Cardiac arrest developed in 97 cases, including 56 who were out of the hospital and 41 who were in the hospital. Fifty of these patients returned to spontaneous circulation, and just one of these had an initial ETCO₂ value below 10 mmHg. The mean of the final ETCO₂ levels was 36.4±4.46 among Patients who Return to Spontaneous Circulation (RSCPs) and 11.74±7.01 among those that died. In all rhythms; Asystole, pulseless electrical activity (PEA) and VF/VT; Overall, RSCPs had higher ETCO₂ levels than the cases who died. Among the PEA patients undergoing in-hospital arrests and those asystolic patients undergoing out of hospital arrest, the ETCO₂ values of the RSCPs were significantly higher than those of the cases who died.

Conclusions

ETCO₂ levels predicted survival as well as the effectiveness of CPR for patients who received CPR and were monitored by capnometry in the emergency department. As a result, we believe that it would be suitable to use capnometry in all units where the CPR is performed.