I think you are not understanding what I meant.
I am not suggesting maintaining at 35 or anywhere near there. When intubating, both the spo2 and etco2 decline when you pause ventilation to intubate. (which of course you have to)In both the theatre and the icu, where i do my clinical time, 35mm/hg is considered the lowest etco2 is permitted to get prior to suspending any procedure attempts (like intubating, because you may have started with a conscious sedation, an LMA or not on a vent for whatever the reason) to resumption of ventilation. If the alarm is sounded because of delays for whatever the reason, that is considered a fault. (unacceptable practice)
Prior to or after the intubation attempt, we like our ETCO2 between 40-45mmhg. Prior to hyper oxygenating for an ET attempt, we usually don't let etco2 reach 50 or above unless there are special circumstances calling for it.
I can see the argument for increasing ETCO2 beyond 50 in a code to attempt to compensate for potential acidosis, but there is also a valid argument that a nonperfusing person actually needs less ventilatory support than a live person. Considering that there is ample documentation of reperfusion injury (because most places I know actually vent with 100% o2 on a code) as well as long term potential toxic effects of 02, unless providers start ventilating with room air as is the trend with neonates, or reduced oxygen levels in adults, I do not see a compelling reason to increase etco2 past normal ranges in the absence of a prolonged downtime or specific pathologies that would benefit from it.
Meclin,
I was taught not to pause for compressions. In all the places I have worked it seems to be the norm. Even in the hospital, on a difficult airway, there are many gadgets available to assist with a difficult intubation, and not shortage of expertise.
If it looks difficult in the field, my last service used combitubes, so we just stuck that in rather than try an ET attempt.
