ETCO2 in cardiac arrest

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FR Wrath

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I'm having conflicting issues. I understand that having a sudden CO2 spike is supposed to indicate ROSC, but I have worked SO many codes that their CO2 will remain anywhere from 20-50 and be in complete asystole. What is going on here?
 
FR Wrath said:
I'm having conflicting issues. I understand that having a sudden CO2 spike is supposed to indicate ROSC, but I have worked SO many codes that their CO2 will remain anywhere from 20-50 and be in complete asystole. What is going on here?
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A potentially viable patient and awesome CPR? Or, respiratory induced asystole with lots of CO2 build up? There's a big difference between 20 and 50.
 
And you want to look for a sudden increase. A patient who goes from 18 to 50 is an indication of impending ROSC. We frequently work codes that never attain ROSC, but keep an ETCO2 in the 20s. (Thanks LUCAS.)
 
A sudden increase in CO2 MAY indicate a ROSC. It could simply mean someone is compressing harder that before. Maybe a new compressor came in, there was excessive ventilation which has now stopped, or maybe some ribs broke and resistance has changed. An increase in CO2 can mean a lot of things, just keep checking the patient. As long as you're above 10 mmHg, you're fine.
 
Really? Broken ribs will increase ETCO2? Explain to me how that works...
 
Less resistance for compressions would cause an increase in ETCO2 since you would be able to compress further. More a dislocated sternum vs broken ribs I guess.
 
DEmedic said:
Really? Broken ribs will increase ETCO2? Explain to me how that works...
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Um… maybe you should take a look at an anatomy book again? Clearly our ribs are hollow (like birds, duh) and filled with CO2. In fact, it's becoming widely recognized that gas exchange is actually occurring within the ribs rather than in the lungs. So yeah, obviously breaking ribs (which is what we're aiming for with CPR, isn't it?) is going to spike your CO2 levels.

;)
 
I knew I was missing an important part of that! Hollow bones! Of course.
 
He's an ACLS instructor; maybe it's coming out in the newest update... :unsure: :blink:
 
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If you have less resistance, from breaking or dislocating the sternum, that would make a compression easier. Higher quality compressions would cause ETCO2 to increase. Just as switching to a new compressor would.....If I'm missing something or incorrect, how about actually giving useful points instead of sarcasm?
 
Scroll to the bottom of the page and read what usafmedic45 wrote.

http://www.emtlife.com/archive/index.php/t-13618.html

Yes, you may break ribs or the sternum (more likely the costal cartilage). Should the goal be to simply break stuff and hear crunching? No. But doing proper, vigorous CPR may cause some damage.

Yes, great CPR will cause a rise in ETCO2 in an arrest. But again, the way you determine great CPR shouldn't be by how much crunching the chest makes, but by controlling depth and rate.
 
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ETCO2 has a sudden spike when ROSC occurs..

However outside variables can cause changing ETCO2 different person performing compressions. Hyper,Hypo ventilating the patient. Tube Dislodgement, loss of the airway etc.

to the OP. if you see a sudden spike in ETCO2. and your unsure. Just go back to BLS. Check a pulse

I agree that all the bells and whistles we have make great for diagnosis and show changes in our patients, but don't use them to substitute for the basics.
 
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