Capnography in Cardiac Arrest
6:03. Person not breathing. We arrive at 6:10, enter the house walk through a narrow hallway,and then down a narrow staircase, and then around some big furniture to a basement bedroom where the first responders are doing CPR.
The man is in his late fifties with a diaylsis port hanging out of his chest. He's warm. Family says he was talking to them shortly beforehand. A witnessed address. He's asystole now. I intubate him. End Tidal CO2 shows a good wave form with a reading between 17 and 23.
We work him hard. Doing the new CPR. I get an EJ and in go the drugs. Epi and Atropine. I give him some Calcium. Next thing I know the ET CO2 is up to 35. We stop compressions. He's got an organized rythmn and a pulse. BP is 124/80.
It is now 6:30 -- a half hour into the call. We have to package him. Fortunately we can go out through a backdoor, but there will be a hill to push him up. As soon as we get him outside, the capnography drops down to 18. Back to CPR. More epi/atropine. Capnography gets him back up. We lose him again as we push up the hill, but regain ROSC as we near the hospital at 7:00.
Pulling him out of the stretcher, something happens with the wheel release and the stretcher slams hard down on the steps. I look at the monitor. A good wave form. The tube is still good.
Going down the hall, he starts to fade out again, and even though his ETCO2 is 32, we start CPR. The rythmn looks idioventricular. They work him awhile longer at the hospital, but he doesn't make it.
The capnography was very instructive. It did the following:
1) Confirmed initial placement of the tube.
2) Alerted us to ROSC three times.
3) Whenever we were doing CPR and the number started to fall, we switched compressors and the number came back up. At one point, I told my partner if he could get the ETCO2 up from 16 to 20, I'd buy at Dunk'n Doughnuts. He started pounding the CPR and the number slowly climbed all the way up to 28. Stopped compressions, the number fell off the cliff almost right away.
4) Continuously confirmed placement of tube during transport and patient handling.