The use of transcutaneous CO₂ monitoring in cardiac arrest patients: A feasibility study

Background: Prediction of the return of spontaneous circulation (ROSC) in cardiac arrest patients is a parameter for deciding when to stop cardiopulmonary resuscitation (CPR) or to start extracorporeal CPR. We investigated the change in transcutaneous PCO2 (PtcCO₂) in cardiac arrest patients. Methods: This study was carried out as a retrospective chart review. Patients with out-of-hospital cardiac arrest or in-hospital cardiac arrest within the emergency department were included. PtcCO₂ monitoring with a V-Sign™ combined monitor (SenTec Inc., Therwil, Switzerland) was applied to patients at the start of CPR. We divided the included patients into the ROSC group and the no ROSC group. The ROSC group was subdivided into those achieving ROSC < 15 min CPR and > 15 min CPR. The change in the PtcCO₂ value was analyzed at 0 min, 5 min, 10 min, and 15 min from PtcCO₂ stabilization and was compared among the groups. Results: A total of 42 patients were enrolled. Twenty-eight patients achieved ROSC; 13 patients achieved ROSC <15 min CPR and 15 patients achieved ROSC > 15 min CPR. Fourteen patients expired without ROSC. The absolute values of PtcCO₂ was lower in the ROSC group than in the n0o ROCS group. The PtcCO₂ change over time had a tendency to decrease or to remain constant in the ROSC groups. In contrast, all patients in the no ROSC group experienced an increase in the PtcCO₂ change during CPR except one case. Conclusions: PtcCO₂ monitoring provides non-invasive, continuous, and useful monitoring in cardiac arrest patients.