Other techniques as volumetric capnography (VCAP) offer a representation of CO 2 production, transport and elimination, that could be useful during CPR, although they might not be always available in a CPR setting 8.
Time-based capnography, widely accessible, provides valuable information such as end-tidal carbon dioxide (EtCO 2) values and capnography wave analysis. Therefore, the European Resuscitation Council guidelines 5 advocate its use to monitor ETT position and state that it can help to rapidly detect ROSC, but do not recommend it as a marker of CPR quality, while the American Heart Association Guidelines 6 state that EtCO 2 monitoring may be considered to assess the quality of chest compressions 7. Regarding pediatric CPR, there is insufficient evidence supporting the use of end-tidal carbon dioxide (EtCO 2) as a as a marker of quality or as a prognostic marker during CPR. Moreover, a retrospective study that analyses 426 out-of-hospital cardiac arrest cases suggest an association between capnographic values and return of spontaneous circulation (ROSC) 4. It has multiple applications that include verifying adequate endotracheal tube position and assessing quality of chest compressions in adult CPR 2, 3. Therefore, these parameters are not adequate to measure ventilation during CPR.Ĭapnography is a useful monitoring technique in cardiopulmonary resuscitation (CPR) 1. EtCO 2 and VCO 2 showed an inverse correlation with PCO 2. Our findings suggest that EtCO 2 is the best VCAP-derived parameter for predicting ROSC. EtCO 2 also had an inverse correlation with PCO 2 from minute 18 to 24 of resuscitation. VCO 2 and VCO 2/kg showed an inverse correlation with PCO 2, with a higher correlation coefficient as resuscitation progressed. No statistical differences were obtained regarding VCO 2, VCO 2/kg and EtCO 2/VCO 2/kg ratios. EtCO 2 was the best predictor of ROSC (AUC 0.72, p < 0.01 and optimal cutoff point of 21.6 mmHg). Seventy-nine piglets were included, 26 (32.9%) of whom achieved ROSC. End-tidal carbonĭioxide (EtCO 2), CO 2 production (VCO 2), and EtCO 2/VCO 2/kg ratio were continuously recorded. CPR was continued until ROSC or 24 min of resuscitation. Airway management was performed with early endotracheal intubation or bag-mask ventilation, according to randomization group. Asphyxial CA was induced by sedation, muscle relaxation and extubation. A secondary analysis of a randomized study was performed to study the relationship between volumetric capnography (VCAP) and arterial CO 2 partial pressure (PCO 2) during cardiopulmonary resuscitation (CPR) and to analyze the ability of these parameters to predict the return of spontaneous circulation (ROSC) in a pediatric animal model of asphyxial cardiac arrest (CA).
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