END-TIDAL
CARBON DIOXIDE MONITORING OPTIMISES MANAGEMENT DURING IN-HOSPITAL CARDIAC
ARRESTS. M. Heily*, L.E.Grigg, CCU, The Royal Melbourne Hospital, Melb.,Vic. Background:
End-Tidal carbon Dioxide (ETCO2) monitoring is commonly used for intubated
patients in critical care, anaesthetic and emergency department areas. It is
not standard monitoring for Advanced Life Support (ALS) management during
in-Hospital cardiac arrests attended by the Cardiac Arrest Team (CAT) at the
Royal Melbourne Hospital. Methods:
To investigate the value of ETCO2 during in-hospital cardiac arrests, the CAT
conducted an observational study on consecutive patients who required
intubation and ventilation after the arrest call. A portable, mainstream
capnograph (Tidal Wave Sp, Novametrix,
USA) was connected to the endotracheal tube (ETT) at intubation. Between
May-December 1999, clinical decisions made for 47 patients in direct response
to the capnograph were documented. Twenty-three patients were in
cardio-repiratory arrest (49%). The remaining 24 patients (51%) were in
pre-arrest states. Results:
Six patients (12%) had the ETT successfully adjusted, (one reintubation, and
one tracheostomy tube change). The other 41 patients (87%) had confirmation of
correct ETT position. Ventilation adjustments prior to arterial blood gas
analysis were made in 15 patients (32%). Four patients (8%) required alteration
in cardiac compressions, or operator change. Fluctuations in ETCO2 and waveform
were noted in 16 patients (34%) as cardiac output and patient condition varied
through the course of the resuscitation. For 12 patients (25%) ETCO2 was used
when deciding continuation or cessation of ALS. A total of 37 interventions
(average 0.8 per patient) and 57 decisions (average 1.2 per patient) were made
in direct response to the ETCO2 monitoring. Conclusion:
ETCO2 monitoring optimises the immediate management of patients who require ALS
during in-hospital cardiac arrests and medical emergencies.
