End-Tidal Carbon Dioxide Monitoring During Cardiopulmonary Resuscitation: A Prognostic Indicator for Survival

The effectiveness of ongoing cardiopulmonary resuscitation efforts is difficult to evaluate. Recent studies suggest that carbon dioxide excretion may be a useful noninvasive indicator of resuscitation from cardiac arrest. A prospective clinical study was done to determine whether end-tidal carbon dioxide monitoring during cardiopulmonary resuscitation could be used as a prognostic indicator of resuscitation and survival. Thirty-five cardiac arrests in 34 patients were monitored with capnometry during cardiopulmonary resuscitation during a 1-year period. Nine patients who were successfully resuscitated had higher average end-tidal carbon dioxide partial pressures during cardiopulmonary resuscitation than 26 patients who could not be resuscitated (15 +/- 4 vs 7 +/- 5 mm Hg). The 3 patients who survived to leave the hospital had a higher average end-tidal carbon dioxide partial pressure than the 32 nonsurvivors (17 +/- 6 vs 8 +/- 5 mm Hg). All 9 patients who were successfully resuscitated had an average end-tidal carbon dioxide partial pressure of 10 mm Hg or greater. No patient with an average end-tidal carbon dioxide partial pressure of less than 10 mm Hg was resuscitated. Data from this prospective clinical trial indicate that findings from end-tidal carbon dioxide monitoring during cardiopulmonary resuscitation are correlated with resuscitation from and survival of cardiac arrest.

[1]  G. Ewy,et al.  Importance of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest. , 1985, Journal of the American College of Cardiology.

[2]  G A Ewy,et al.  Expired PCO2 as an index of coronary perfusion pressure. , 1985, The American journal of emergency medicine.

[3]  G. Ewy,et al.  Changes in expired end-tidal carbon dioxide during cardiopulmonary resuscitation in dogs: a prognostic guide for resuscitation efforts. , 1989, Journal of the American College of Cardiology.

[4]  J. Rosborough,et al.  Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation. , 1985, Annals of emergency medicine.

[5]  F. Weale,et al.  The efficiency of cardiac massage. , 1962, Lancet.

[6]  G A Ewy,et al.  Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest. , 1984, Annals of emergency medicine.

[7]  E. Cook,et al.  Survival after Cardiopulmonary Resuscitation in the Hospital , 1983 .

[8]  M. Weil,et al.  Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. , 1986, The New England journal of medicine.

[9]  M. Weil,et al.  Cardiac output and end‐tidal carbon dioxide , 1985, Critical care medicine.

[10]  G. Ewy,et al.  Coronary perfusion pressure during cardiopulmonary resuscitation. , 1985, The American journal of emergency medicine.

[11]  H. Halperin,et al.  Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. , 1986, Circulation.

[12]  J P Ornato,et al.  End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. , 1987, JAMA.

[13]  M. Weil,et al.  Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation. , 1988, Circulation.

[14]  Z Kalenda,et al.  The capnogram as a guide to the efficacy of cardiac massage. , 1978, Resuscitation.

[15]  G. Ewy,et al.  Prognostic and therapeutic importance of the aortic diastolic pressure in resuscitation from cardiac arrest , 1984, Critical care medicine.

[16]  M. Weil,et al.  End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. , 1988, The New England journal of medicine.

[17]  M. C. Rogers,et al.  Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. , 1984, Circulation.

[18]  C. Babbs,et al.  Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: improved regional blood flow and resuscitation in dogs. , 1984, Annals of emergency medicine.

[19]  S. Badylak,et al.  Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation. , 1987, Circulation.

[20]  R. Coomaraswamy,et al.  CARDIAC OUTPUT AND OTHER HEMODYNAMIC VARIABLES DURING EXTERNAL CARDIAC MASSAGE IN MAN. , 1963, The New England journal of medicine.

[21]  G. Ewy,et al.  Resuscitation and arterial blood gas abnormalities during prolonged cardiopulmonary resuscitation. , 1984, Annals of emergency medicine.

[22]  J. Redding Abdominal Compression in Cardiopulmonary Resuscitation , 1971, Anesthesia and analgesia.