This week I chatted with Tom Bouthillet (@tbouthillet) on the topic of all things cardiac arrest ventilation. We discussed where in his workflow he switched from BVM to an advanced airway, how he uses ETCO2 to guide resuscitation, and some ETCO2 waveforms specific to cardiac arrest that you need to have on your radar.
Dr. Weingart from EMCRIT just released an interesting episode regarding the following ETCO2 waveforms with Per-Olav Berve. I highly recommend listening to this one as well. You can find the blog and podcast associated with that episode here.
I mapped out my current workflow for troubleshooting a low ETCO2 below.
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This interview comes from the cardiac arrest update in FOAMfrat Studio. If you want to get CAPCE-accredited CEs and learn more. Click the link below and sign up!
References:
Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004 Sep;32(9 Suppl):S345-51. doi: 10.1097/01.ccm.0000134335.46859.09. PMID: 15508657.
Holmén J, Hollenberg J, Claesson A, Herrera MJ, Azeli Y, Herlitz J, Axelsson C. Survival in ventricular fibrillation with emphasis on the number of defibrillations in relation to other factors at resuscitation. Resuscitation. 2017 Apr;113:33-38. doi: 10.1016/j.resuscitation.2017.01.006. Epub 2017 Jan 18. PMID: 28109996.
Lesimple, A., Fritz, C., Hutin, A. et al. A novel capnogram analysis to guide ventilation during cardiopulmonary resuscitation: clinical and experimental observations. Crit Care26, 287 (2022). https://doi.org/10.1186/s13054-022-04156-0
Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M, Nowak RM. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990 Feb 23;263(8):1106-13. PMID: 2386557.
Yannopoulos D, Bartos J, Raveendran G, Walser E, Connett J, Murray TA, Collins G, Zhang L, Kalra R, Kosmopoulos M, John R, Shaffer A, Frascone RJ, Wesley K, Conterato M, Biros M, Tolar J, Aufderheide TP. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. doi: 10.1016/S0140-6736(20)32338-2. Epub 2020 Nov 13. PMID: 33197396; PMCID: PMC7856571.