Abstract
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.
Keywords
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Article info
Publication history
Published online: July 02, 2009
Accepted:
April 16,
2009
Received in revised form:
January 19,
2009
Received:
November 5,
2007
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
