Advanced Life Support 6th Edition January 2011 ISBN 978-1903812228.With increasing cardiac arrest capnography data accumulating, there is reasonable hope that predictors of outcome and determining CPR duration will become more accurate in the future. However, factors determining EtCO2 are complex and rates of minute ventilation and CO2 production need to be considered when interpreting this.įurther research is needed to define appropriate EtCO2 targets during resuscitation, in an effort to improve outcome following cardiac arrest. An EtCO2 concentration of 25 mmHg might be an appropriate target during resuscitation, indicating the need for optimally effective chest compressions. Current evidence indicates higher EtCO2 in cardiac arrest with ROSC. In the absence of protocolised intermittent positive pressure ventilation through a mechanical ventilator, EtCO2 values will vary from case to case and values are less reliable as a predictor of outcomeĬapnography is a useful tool to guide treatment in cardiac arrest. In both studies there is no standardisation of minute ventilation delivered during cardiac arrest. What is the role of capnography in cardiac arrest? Following discussion with the team, and on the grounds of futility, the resuscitation attempt was abandoned. Blood gas analysis revealed a severe metabolic acidosis (pH 6.8, lactate 15.2 mmol/L) and by this stage the highest EtCO2 recorded was 0.9 kPa. The rhythm had changed to pulseless electrical activity, and despite effective CPR, administration of adrenaline and fluids, there was no return of spontaneous circulation (ROSC).
Chest auscultation was performed and air entry was confirmed as being equal bilaterally.Ĭhest compressions continued uninterrupted and by this stage the overall resuscitation attempt had been ongoing for 45 minutes. The initial capnography indicated a flattened end tidal carbon dioxide (EtCO2) trace with a highest partial pressure of 1.5 kPa. Sidestream capnography was connected to a self-inflating bag administering high-concentration oxygen. Vomitus was aspirated from his endotracheal tube, indicating pulmonary aspiration either at the time of collapse or during the resuscitation attempts. Īssessment of the patient’s airway on arrival in the Emergency Department revealed evidence of vomit in the pharynx, and endotracheal intubation was performed. Early and effective CPR, early defibrillation and physiological support post-resuscitation form the chain of survival. Ischaemic heart disease is the leading cause of death in the world, and sudden cardiac arrest is responsible for more than 60% of adult deaths from coronary heart disease. His airway was supported with an I-Gel supraglottic airway device, and he was transferred to hospital urgently. Despite appropriate advanced life support with defibrillation and administration of adrenaline and amiodarone over multiple cycles. On arrival, the Paramedic crew found him to be in ventricular fibrillation was the predominant rhythm. He had a background of ischaemic heart disease, insulin-dependent diabetes, peripheral vascular disease and hypertension. He had complained of sudden onset upper abdominal pain to his wife immediately prior to a collapse, and bystander cardiopulmonary resuscitation (CPR) was commenced whilst emergency services were called. A 68 year-old gentleman was admitted to the Emergency Department in cardiac arrest.
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