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During the past decade, there has been a significantly increased focus on optimal performance of high-quality chest compressions for patients in cardiac arrest. Maintenance of proper rate and depth of compressions is critical. Another critical element concerns continuous chest compressions; the interruptions that occur for pulse checks and other interventions are detrimental to maintenance of perfusion and the success of the resuscitation. The use of continuous end-tidal carbon dioxide (PETCO2) monitoring for patients during chest compressions appears to hold promise for obviating the need for pulse checks. The authors of this study evaluated 108 patients with cardiac arrest who were receiving advance life support measures and who had continuous PETCO2monitoring. The authors retrospectively compared the PETCO2 of 59 patients who had return of spontaneous circulation (ROSC) followed by stable spontaneous circulation vs that of 49 patients who had no ROSC. The mean initial PETCO2 of all patients before ROSC (during compressions) was 26.6 ± 12 mmHg. The mean PETCO2 after ROSC in the survivors was 36.6 ± 12 mm Hg (P b .0001). The mean increase in PETCO2 after ROSC was 10.0 mmHg (P b .001), and the 95% confidence interval (CI) of the difference was 6.5-13.5 mm Hg. Evaluation of the PETCO2 waveform from all 59 patients with ROSC demonstrated that the significant increase occurred at the moment of ROSC. The authors caution against use of absolute levels of PETCO2 because 6 of 59 survivors started with very low levels (b10 mm Hg), and also 4 of 49 patients without ROSC started with high levels (N41 mm Hg). An abrupt, absolute increase in PETCO2 during compressions of at least 10 mm Hg appears to be a reliable indicator of ROSC. Using this information, it would seem advisable to perform continuous compressions without interruptions for pulse checks until either resuscitative efforts are discontinued or an abrupt increase of PETCO2 ≥10 mm occurs. This study, compromised of a small sample of patients, suggests that PETCO2 monitoring can be used as a means of determining the ROSC without interrupting chest compressions—further data and additional clinical experience with this recommendation likely are needed before widespread implementation. |
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