End Tidal CO2

End Tidal CO2, or ETCO2 for short, is something that’s talked about pretty often in Emergency and Critical Care and that’s because it’s used a lot in the assessment and treatment of patients!

It’s got a big part to play in airway management, resuscitation, sedation and is also increasingly used in other situations. Some of these applications have some pretty strong evidence to back them up but others are definitely worth a deeper thought, because without a sound understanding of ETCO2 we can fall foul of some traps…

ETCO2 is a non-invasive measurement of the partial pressure of CO2 in expired gas at the end of exhalation. Ideally we’d like to know what’s really going on arterially with the partial pressure of arterial CO2 but we can use the end tidal because that’s an easy reading to get from exhaled breath, when it will most closely resemble the alveolar CO2 concentration.

Its value is reflective of ventilation but also really importantly is affected by the circulation, the circuit and how it’s applied. In the podcast we run through all of these aspects, its application to clinical care and also some of its pitfalls.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

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References

Internet Book of Critical Care; ETCO2

The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review. Resuscitation. Paiva. 2018

Patient safety during procedural sedation using capnography monitoring: a systematic review and meta-analysis. Saunders. BMJ. 2016

Exhaled end-tidal carbon dioxide as a predictor of lactate and pediatric sepsis. Cully. Am J Emerg Med. 2020

The Use of End-Tidal Capnography to Monitor Non-Intubated Patients Presenting with Acute Exacerbation of Asthma in the Emergency Department. Howe. Emerg Med. 2011

Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. Chebl. BMC Emerg Med. 2016

Utilizing End-Tidal Carbon Dioxide to Diagnose Diabetic Ketoacidosis in Prehospital Patients with Hyperglycemia. Hunter. Prehosp Disaster Med. 2020

Evaluation of Differences between PaCO2 and ETCO2 by Age as Measured during General Anesthesia with Patients in a Supine Position. Satoh. Journal of Anaesthesiology. 2015

End-tidal CO2 as a predictor of survival in out-of-hospital cardiac arrest. Eckstein. Prehosp Disaster Med. 2011

PHEMcast; Episode 20 End Tidal Carbon Dioxide

 

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