What ETCO2 level indicates a problem with chest compressions?

In patients receiving high-quality chest compressions, who have an advanced airway placed, a persistent ETCO2 reading below 10 mm HG after 20 minutes of resuscitation is an indication to terminate efforts [1].

What should ETCO2 be during CPR?

Teams should aim for EtCO2 at least >10 mm Hg and ideally >20 mm Hg. Where do these numbers come from? These values are approximately 1/4 the normal EtCO2 (35-45 mm Hg), and ideal CPR will provide at least 1/4 of cardiac output. This is an example of capnography during CPR.

What is the main determinant of ETCO2 during CPR?

During low-flow states with relatively fixed minute ventilation, pulmonary blood flow is the primary determinant of ETCO2 . During cardiac arrest, ETCO2 levels reflect the cardiac output generated by chest compression.

How does ETCO2 correlate with cardiac output?

We conclude that the increase in Pvco2 and the concurrent decrease in ETco2 reflect a critical reduction in cardiac output, which reduces alveolar blood flow to the extent that carbon dioxide clearance by the lung fails to keep pace with systemic CO2 production.

What does low ETCO2 mean?

So a high ETCO2 is a good sign of good ventilation, while low ETCO2 is bad sign that represents hypoventilation. If the patient has slow or shallow respirations, it means he is retaining CO2 in his blood, so less CO2 will pass through his airway, then a low ETCO2 will show on the monitor.

When providing high quality CPR to an adult what is the proper rate for chest compressions?

Gently compress the chest about 1.5 inches (about 4 centimeters). Count aloud as you push in a fairly rapid rhythm. You should push at a rate of 100 to 120 compressions a minute, just as you would when giving an adult CPR .

Why capnography is used in CPR?

Measurement of end-tidal expiratory pressure of carbon dioxide (ETCO2) using capnography provides a noninvasive estimate of cardiac output and organ perfusion during cardiac arrest and can therefore be used to monitor the quality of CPR and predict return of spontaneous circulation (ROSC).

What is a chest compression fraction?

The chest compression fraction was defined as the proportion of resuscitation time without spontaneous circulation during which chest compressions were administered.

Why does ETCO2 decrease with hypotension?

The larger decrease in ETCO2 during controlled hypotension is mainly due to the increase in the Vdphys/Vt and V/Q ratios.

What happens if ETCO2 is high?

Think respiratory failure when ETCO2 is high The height of the capnography waveform accompanies this number on the monitor, as well as the respiratory rate. In severe cases of respiratory distress, increased effort to breathe does not effectively eliminate CO2.

What is the CPR compression rate?

Place the heel of your hand on the centre of the person’s chest, then place the palm of your other hand on top and press down by 5 to 6cm (2 to 2.5 inches) at a steady rate of 100 to 120 compressions a minute. After every 30 chest compressions, give 2 rescue breaths.

What is the best fraction for chest compressions?

The chest compression fraction (CCF) is the proportion of time spent performing chest compressions during arrest, and a CCF of above 80% has been recommended. However, few data exist on the effectiveness of a higher CCF on clinical outcomes.

Why do we use end tidal CO2?

In critical care, End Tidal CO2 monitoring is used to assess adequacy of circulation to the lungs, which provides clues about circulation to the rest of the body. Low EtCO2 with other signs of shock indicates poor systemic perfusion, which can be caused by hypovolemia, sepsis or dysrhythmias.

How can you give a high chest compression fraction?

Achieving a rate of 100–120 compressions per minute. Compressing the chest to a depth of 2–2.4 inches (5–6 centimeters) Avoiding leaning on the chest to allow for full chest wall recoil after each compression. Minimizing pauses in compressions (chest compression fraction > 60%)

How do you assess CPR quality intubated patient?

For the intubated patient in cardiac arrest, quantitative waveform capnography is now considered the desired method for monitoring the quality of chest compressions and determining when the patient has a ROSC.

What does end-tidal CO2 tell you?

ETCO2 provides clues about respiratory effort We assess this by observing chest rise and fall, assessing respiratory effort, counting respiratory rate, and listening to breath sounds. ETCO2 adds an objective measurement to those findings.

What happens to ETCO2 during hypoventilation?

We know that elevated ETCO2 (hypercapnia) occurs during hypoventilation, and a decrease in ETCO2 (hypocapnia) occurs with hyperventilation. Many capnographs also display a capnogram, or waveform which diagrams inspiration and exhalation over time.

What should petco2 be during CPR?

waveform during CPR Optimize chest compression for effective CPR so that PETCO 2 values are between 10 and 20 mm Hg. If PETCO 2 values less than 10 mm Hg or less measured after initiation of ACLS is associated with poor outcome

How to fix high ETCO2?

– Kraus B. Advances in the use of capnography for non-intubated patients. – Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations. – Davis DP, Dunford JV, Ochs M, et al.

What is the normal range for ETCO2?

One of the great things about EtCO 2 is that although ventilation rates vary based on age, normal readings for quantity, shape and trends are the same for men and women of all age groups, making them easy to remember. Quantity; target EtCO 2 value should be 35-45 mmHg.

How to increase ETCO2?

– exhibiting prolonged sedation, – with opioid induced respiratory depression, – history of sleep apnea, – any cardiovascular instability – any time they are worried about a particular patient.