Resident Journal Review: End-Tidal Carbon Dioxide Monitoring in Cardiopulmonary Resuscitation

Authors: Christianna Sim, MD MPH; Taylor Conrad, MD MS; Taylor M. Douglas, MD; Wesley Chan, MD

Editors: Kelly Maurelus, MD FAAEM and Kami Hu, MD FAAEM

Originally published: Common Sense
November/December 2020

Question: How can end-tidal carbon dioxide (ETCO2) monitoring guide our management of cardiac arrest?

In 2010, the American Heart Association (AHA) revised the Advanced Cardiac Life Support (ACLS) guidelines to include the recommendation of using capnography to monitor end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR),¹ and has continued this recommendation to date. Measured ETCO2 during cardiac arrest is a measure of the cardiac output generated by chest compressions but is affected by various other factors including endotracheal tube complications, ventilation, and medications administered. These issues notwithstanding, studies supporting ETCO2 as a surrogate marker of cardiac output outside of cardiac arrest^2,3 indicate that ETCO2 could be a non-invasive, more readily available means of providing feedback in real time during resuscitation efforts. Previous studies have shown that low (<10 mmHg) ETCO2 values during resuscitation are predictive of mortality^4,5,6 and that initial, average, and final ETCO2 are higher in successfully resuscitated patients^7,8 and there is an emerging possibility that ETCO2 could possibly even predict survival to discharge.^7,9 Here we review some of the more recent literature regarding the use of ETCO2 during CPR and evidence on how it can guide resuscitation efforts. 

Virtual Insanity: Adapting Curriculum to the Virtual Environment

Image credit: Pexels

Author: Ryan Gibney, MD
AEM/RSA Editor
Originally published: Common Sense
November/December 2020

The sun peaks over the bay, as the crispness evaporates from the morning air to greet, what — in any other normal time — would be the start of a new school year. The traditional morning routine of packing lunch, gathering supplies, and a haphazard scurry to the front door to make it to class on time, has all but disappeared. The start of a new school year as a parent has brought a new face to education across the board. In my home, we have set up a dedicated learning space for both my daughter and I, complete with paper, pens, computers, reference books, and any other tool that may be needed. As I watch my daughter dive into the realm digital learning, I wonder how this generation is going to adapt. How are they going to apply their knowledge? Is this the new norm for education (please, God I hope not)? More importantly, how will the lack of social interaction shape her future? It has been shown that peer education with regards to emotional resiliency, empathy, and problem solving, are attained through social interactions. I believe that the same is true in medical education.