2010 AHA Capnography Guidelines

The new 2010 American Heart Association Guidelines now endorse wave form capnography as a Level I recommendation for ET tube verification, a Level IIa reccomendation for detecting return of spontaneous circulation and a IIb for monitoring CPR quality.

Part 8: Adult Advanced Cardiovascular Life Support

Here are the excerpts:

On ET Confirmation

Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube (Class I, LOE A).

Notes:

Waveform capnography should be used "to confirm and monitor endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any patient transfer to reduce the risk of unrecognized tube misplacement or displacement."

Studies on wave form capnography "have shown 100% sensitivity and 100% specificity in identifying correct endotracheal tube placement."

Colormetric ETCO2 devices should only be used "when waveform capnography is not available (Class IIa, LOE B)."

On Monitoring CPR Quality

It is reasonable to consider using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect ROSC during chest compressions or when rhythm check reveals an organized rhythm (Class IIb, LOE C).

On Indicating ROSC

If PETCO2 abruptly increases to a normal value (35 to 40 mm Hg), it is reasonable to consider that this is an indicator of ROSC (Class IIa, LOE B).