The effectiveness of ongoing cardiopulmonary resuscitation (CPR) efforts is difficult to evaluate. During a cardiac arrest and attempted resuscitation, there are no readily available noninvasive measurements that identify patients who are likely
to
have
return of spontaneous circulation (ROSC). A number of studies in animals and humans suggest that systemic perfusion during arrest and CPR is related to the end-tidal volume of carbon dioxide, which is an indirect measure of pulmonary perfusion. A
clinical study was done to determine whether end-tidal carbon dioxide (PetCo2) monitoring during CPR could be used as a prognostic useful noninvasive indicator of resuscitation and survival. The concentration of expired carbon dioxide was
measured
continuously with caphnography-BCI Model 9000 Caphnographer/Oximeter (Biochemical International, Inc., Waukesha, WI). To evaluate its clinical applicability, we performed prospective, bedside measurements of the PetCO2 in patients after cardiac
arrest
and during CPR. We measured the PetCO2 during 20 episodes of adult nontraumatic cardiac arrest and resuscitation in 16 critically ill patients during December, 1994 through February, 1995.
Spontaneous circulation was restored in eight victims(40%). The mean PetCO2 of successfuly resuscitated group (ROSC, N=8, 23.6±5.5 mmHg) was higher than that of nonresuscitated group (non ROSC, N=12, 8.7±3.0 mmHg) (p<0.05). the three patients
survived
more than 24 hours had a higher mean PetCO2 than that of the 17 patients survived less than 24 hours(28.0±6.0 vs 12.3±6.5 mmHg) (p<0.05). All eight patients who were successfully resuscitated had a PetCO2 of 15 mmHg or greater. No patient with
a
PetCO, of less than 15 mmHg was resuscitated. We concluded PetCO2 monitoring during CPR are correlated with resuscitation from cardiac arrest. We also propose that measurement of the PetCO2 may be a practical and noninvasive method for monitoring
blood
flow generated by precordial compression during CPR, and may be an almost immediate indicator of successful resuscitation.
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