A Sudden Increase in Partial Pressure End-Tidal Carbon Dioxide (PETCO2) at the Moment of Return of Spontaneous Circulation


      Background: Previous studies established that a level of partial pressure end-tidal carbon dioxide (PETCO2) of 10 mm Hg divided patients undergoing advanced life support (ALS) into those likely to be resuscitated (values > 10 mm Hg) and those likely to die during ALS (values < 10 mm Hg). Objective: The study tested the significance of a sudden increase in the PETCO2 in signaling the return of spontaneous circulation (ROSC) during ALS. Material and Methods: PETCO2 values were continuously recorded during ALS in out-of-hospital patients with cardiac arrest. Constant ventilation was maintained by an automatic device. There were 108 patients, representing two extreme outcomes of ALS, who were subdivided into two groups. The first group included 59 patients with a single ROSC followed by a stable spontaneous circulation. The second group included 49 patients with no signs of ROSC. Results: ROSC was associated with a sudden increase in PETCO2 that remained significantly higher than before ROSC. PETCO2 did not rise during the entire ALS in the second group of patients without ROSC and was lower than in the first group of patients. Conclusions: In constantly ventilated patients, PETCO2 is significantly higher (about 10 mm Hg) after ROSC than before ROSC. A sudden increase in PETCO2 exceeding 10 mm Hg may indicate ROSC. Consequently, the rule of 10 mm Hg may be extended to include a sudden increase in continuously recorded PETCO2 by more than 10 mm Hg as an indicator of the possibility of ROSC.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wik L.
        • Kramer-Johansen J.
        • Myklebust H.
        • et al.
        Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.
        JAMA. 2005; 293: 299-304
        • Sigurdsson G.
        • Yannopoulos D.
        • McKnite S.H.
        • Lurie K.G.
        Cardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.
        Curr Opin Crit Care. 2003; 9: 183-188
        • Kalenda Z.
        The capnogram as a guide to the efficacy of cardiac massage.
        Resuscitation. 1978; 6: 259-263
        • Gudipati C.V.
        • Weil M.H.
        • Bisera J.
        • Deshmukh H.G.
        • Rackow E.C.
        Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation.
        Circulation. 1988; 77: 234-239
        • Lepilin M.G.
        • Vasilyev A.V.
        • Bildinov O.A.
        • Rostovtseva N.A.
        End-tidal carbon dioxide as a noninvasive monitor of circulatory status during cardiopulmonary resuscitation: a preliminary clinical study.
        Crit Care Med. 1987; 15: 958-959
        • Garnett A.R.
        • Ornato J.P.
        • Gonzalez E.R.
        • Johnson E.B.
        End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation.
        JAMA. 1987; 257: 512-515
        • Falk J.L.
        • Rackow E.C.
        • Weil M.H.
        End-tidal carbon dioxide concentration during cardiopulmonary resuscitation.
        N Engl J Med. 1988; 318: 607-611
        • Lewis L.M.
        • Stothert J.
        • Standeven J.
        Correlation of end-tidal CO2 to cerebral perfusion during CPR.
        Ann Emerg Med. 1992; 21: 1131-1134
        • Idris A.H.
        • Staples E.D.
        • O'Brien D.J.
        • et al.
        End-tidal carbon dioxide during extremely low cardiac output.
        Ann Emerg Med. 1994; 23: 568-572
        • Shibutani K.
        • Muraoka M.
        • Shirasaki S.
        • Kubal K.
        • Sanchala V.T.
        • Gupte P.
        Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output?.
        Anesth Analg. 1994; 79: 829-833
        • Grmec S.
        • Klemen P.
        Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?.
        Eur J Emerg Med. 2001; 8: 263-269
        • Grmec S.
        • Kupnik D.
        Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting?.
        Resuscitation. 2003; 58: 89-96
        • Wayne M.A.
        • Levine R.L.
        • Miller C.C.
        Use of end-tidal carbon dioxide to predict outcome in prehospital cardiac arrest.
        Ann Emerg Med. 1995; 25: 762-767
        • Levine R.L.
        • Wayne M.A.
        • Miller C.C.
        End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest.
        N Engl J Med. 1997; 337: 301-306
        • Cantineau J.P.
        • Lambert Y.
        • Merckx P.
        • et al.
        End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome.
        Crit Care Med. 1996; 24: 791-796
        • Ahrens T.
        • Schallom L.
        • Bettorf K.
        • et al.
        End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest.
        Am J Crit Care. 2001; 10: 391-398
        • Callaham M.
        • Barton C.
        Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration.
        Crit Care Med. 1990; 18: 358-362
        • Asplin B.R.
        • White R.D.
        Prognostic value of end-tidal carbon dioxide pressures during out-of-hospital cardiac arrest.
        Ann Emerg Med. 1995; 25: 756-761
        • International Liaison Committee on Resuscitation
        The 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.
        Resuscitation. 2005; 67: 213-247
      1. European Resuscitation Council Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Resuscitation 2000;46:1–447.

      2. European Resuscitation Council Guidelines for Resuscitation 2005, consensus on science and treatment recommendations. Resuscitation 2005;67:S1–189, 220–1.

        • Entholzner E.
        • Felber A.
        • Mielke L.
        • et al.
        Assessment of end-tidal CO2 measurement in reanimation.
        Anasthesiol Intensivmed Notfallmed Schmerzther. 1992; 27
        • Grmec S.
        • Lah K.
        • Tusek-Bunc K.
        Difference in end-tidal CO2 between asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia arrest in the prehospital setting.
        Crit Care. 2003; 7: R139-R144
        • Berg R.A.
        • Henry C.
        • Otto C.W.
        • et al.
        Initial end-tidal CO2 is markedly elevated during cardiopulmonary resuscitation after asphyxial cardiac arrest.
        Pediatr Emerg Care. 1996; 12: 245-248
        • Bhende M.S.
        • Karasic D.G.
        • Karasic R.B.
        End-tidal carbon dioxide changes during cardiopulmonary resuscitation after experimental asphyxial cardiac arrest.
        Am J Emerg Med. 1996; 14: 349-350