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> I would be interested > to hear whether, colleagues are routinely using end tidal CO2 > monitoring > in the management of patients in cardiac arrest. Is anyone currently > doing any research on this in UK? Not routinely. > Good thread Julian - as far as I am aware, the ETCO2 is > actually a very useful > prognostic indicator post arrest - if low then they are > unlikely to survive to > hospital discharge, if high then there is a good chance. You > can probably > quote the figures more readily. This may be useful in that it > may help us > decide which of the ROSC's to palliate and which to pull all > the stops out > for. My reading of the literature is subtely different. I read it as: a) EtCO2 < 1.3 kPa (usually quoted as 10 mm Hg because despite having had over 200 years to do so, the Americans still can't accept SI units)= no chance of survival to discharge with reasonable neurological function b) Et CO2 > 1.3= some (rather than good) chance of survival to discharge. However, some criticism in discussion of the papers on the letters page as the original papers don't specifically exclude cases where there was already ROSC when the EtCO2 was measured- indeed I seem to recall that many papers don't specify at what point EtCO2 was measured, and of those that do, it is often taken as a maximal level within a specified period from intubation (i.e. patients with return of spontaneous circulation do better than those without) Rather than my going back and reading the literature properly this time, could Julian please clarify? I'm particulary interested on data on survival to neurologically acceptable outcome at discharge in patients in whom there was a reasonble EtCO2 reading prior to ROSC. This is probably the area of research with the most application- we don't need another paper looking at 100 or so patients and concluding that dead patients stay dead, but those with an output (measured by whatever method including EtCO2) sometimes stay alive. Good subject area for secondary research though- the review articles don't seem to have looked at the important questions (e.g. in which patients can discharge from hospital be predicted by EtCO2 when it couldn't be predicted by other measures) > > There is good quality evidence in the literature to suggest > that it can > provide non invasive information on the quality of chest compressions, So what? BTW, I can't remember if it was ever published, but in Stoke, they looked at EtCO2 with open chest CPR and as you'd expect the levels were considerably higher. > and predict the return of spontaneous circulation before a pulse is > palable, and may be a be a guide to outcome. This is in addition to > confirming the correct placement of the ET tube. > One number can measure one thing, not 4 unless you're saying that low EtCO2 means either (poor quality CPR plus no spontaneous circulation) OR poor outcome regardless of treatment OR misplaced ETT. Which isn't all that useful. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.