Capnography, King of the ABC's: A Systematic Approach for Paramedics

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For hypocapnia, very limited evidence suggests either no benefit or harm, supporting the task force’s suggestion against targeting hypocapnia.

The guidelines reflect the increasing evidence for extracorporeal CPR (eCPR) as a rescue therapy for selected patients with cardiac arrest when conventional ALS measures are failing and to facilitate specific interventions (e.g. coronary angiography and percutaneous coronary intervention (PCI), pulmonary thrombectomy for massive pulmonary embolism, rewarming after hypothermic cardiac arrest) in settings in which it can be implemented. In conditions like an obstructed airway, weakened respiratory muscle, or lung dysfunctions, abnormalities can be detected immediately from the CO2 waveform and PCO2. In pulse oximetry, since oxygen saturation reaches 100% during sedation and general anesthesia, changes in respiration are not detected unless the SpO2 falls below 100% in spite of the fall in PaOfor some reason. For example, in the case when respiration stops while maintaining the SpO2 at 100%, the fall in SpO2 below 100% only occurs after 4 to 5 minutes. With capnography, the CO2 waveform ceases as soon as apnea occurs. Additionally, in cases of deep sedation where there is an increased risk of airway obstruction, CO2 monitoring provides early detection of airway obstruction. [16]

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While ventilation is measured best by looking at CO2 partial pressures, oxygenation is measured by looking at oxygen partial pressures. In the clinical setting, the measurement of the amount of oxygen saturation in blood is via pulse oximeters. They provide a warning about the presence ofhypoxemia to patients. The basis of pulse oximetry is on two principles: (1) the presence of a pulsatile signal that is generated by the arterial blood in the finger and (2) the different wavelengths generated by oxyhemoglobin and reduced hemoglobin.

To further define the relationship between cardiac output (CO) and end-tidal carbon dioxide tension (ETCO2) at various levels of systemic flow. Electrical cardioversion is the preferred treatment for tachyarrhythmia in the unstable patient displaying potentially life-threatening adverse signs.

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Outcome: Prediction of poor neurological outcome defined as CPC 3 to 5 or mRS 4 to 6 at hospital discharge, 1 month, or later For the important outcome of critical care length of stay we identified low-certainty evidence (downgraded for serious risk of bias and serious imprecision) from 2 RCTs 171, 174 enrolling 248 patients, which showed no benefit (mean difference, 0.47 days; 95% CI, –1.31 to 2.24; P=0.61).

The threshold for treating epileptiform activity other than convulsive seizures (eg, generalized epileptiform discharges) is poorly defined. Time frame: In 2015, an ILCOR evidence review identified 4 categories of predictors of neurological outcome after cardiac arrest, namely clinical examination, biomarkers, electrophysiology, and imaging. In the last 4 years, several studies have been published and new predictors have been identified, therefore the topic needs an update. Phase 3 (the red line): This phase is the alveolar plateau. The gently sloping plateau represents late expiration where alveolar gas which is rich in CO 2 is detected. The angle between phase 2 and phase 3 is called the Alpha Angle, the change from airway gas to alveolar gas. The value at the end of the slope is called the End-Tidal CO 2 (ETCO 2), the maximal expired CO 2 concentration. The ETCO 2 is the numeric value on the monitor and is normally 4.5-6 kPa (35 – 45 mmHg). Outcome: Survival to hospital discharge with good neurologic outcome and survival to hospital discharge were ranked as critical outcomes. ROSC was ranked as an important outcome. For antiarrhythmic drugs after ROSC, rearrest was included as an important outcome. For the critical outcome of survival with favorable neurological outcome at ICU discharge or 30 days, we identified low-certainty evidence (downgraded for serious risk of bias and serious imprecision) from 2 RCTs 171, 174 enrolling 254 patients, which showed no benefit of early/prophylactic antibiotic administration (RR, 0.89; 95% CI, 0.71–1.12; P=0.31; risk difference, –0.06; 95% CI, –0.19 to 0.06; P=0.30).Outcome: Survival with favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days, and/or 1 year; survival at discharge, 30 days, 60 days, 180 days, and/or 1 year (all critical); and the important outcome of seizure incidence during index hospitalization (for seizure prophylaxis only)