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CPR
search and rescue
air ambulance
literature review
air ambulance

SAR helicopter paramedic practice: EtCO2 measuring to assist with CPR attempts

02 October 2017
Features
02 October 2017
Volume 9 · Issue 10

Abstract

This article is a review of literature conducted in as systematic manner using the PRISMA statement as a basis for its methodology to answer the following question: How can EtCO2 measuring assist with CPR attempts in SAR Helicopter paramedic practice?’ Results revealed that CO2 coming out of an ET tube indicates that it is in the correct position. An EtCO2 value of <1.33 KPa or an EtCO2 that falls by ≥ 25% of the baseline are the variables most significantly correlated with not achieving ROSC. Diminishing EtCO2 readings may be an indication to increase CC depth, or change a tiring CC provider to optimise CPR attempts. A sudden rise in EtCO2 is a highly specific but non-sensitive marker of ROSC.

The UK Search and Rescue (SAR) helicopter paramedic profession is at an exciting stage in its development. In the UK, there has been a recent transition from a predominantly military provision of service to a wholly civilian one. This transition has brought with it the introduction of greater diagnostic, monitoring and prognostic equipment. One such advancement is a wave-form end-tidal carbon dioxide (EtCO2) monitoring capability.

EtCO2 is the concentration of CO2 in exhaled air, and approximates the partial pressure of CO2 in arterial blood (PaCO2). Values of PaCO2 usually range between 4.6-6 KPa (Valente, 2010; Pantazopoulos et al, 2015). EtCO2levels are dependent on tissue and lung perfusion, alveolar ventilation and tissue metabolism, and are measured using a capnometer (numerical or colour indication), or capnography (graphical and numerical display) device (Valente, 2010; Pantazopoulos et al, 2015). In awake, non-intubated patients, EtCO2 is typically slightly less than PaCO2 by around 0–0.3 KPa; but for the intubated or ill patient, the reduction can be circa 0.8 KPa (Valente, 2010; Pantazopoulos et al, 2015). During cardiac arrest, optimal cardiopulmonary resuscitation (CPR) only achieves around 25–40% of spontaneous cardiac output; as a consequence, EtCO2 levels are reduced (Pantazopoulos et al, 2015). The interpretation of these readings can offer an indication of aerobic metabolism and circulatory efficiency during resuscitation attempts.

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Cardiac arrest
End-tidal carbon dioxide
Capnography
Search and rescue
Paramedic