Clinical Report: Patterns and Variability in End-Tidal Carbon Dioxide Utilization

Overview

Revise to emphasize the implications of the 35.3% utilization for CPR monitoring.

Background

End-tidal carbon dioxide measurement is critical for confirming advanced airway placement and optimizing cardiopulmonary resuscitation (CPR) during cardiac arrest. The American Heart Association recommends its use due to its high sensitivity and specificity in detecting return of spontaneous circulation (ROSC). Despite these guidelines, the actual patterns of EtCO2 utilization in clinical practice remain underexplored.

Data Highlights

Key Findings

• 92.6% of new airways were confirmed with EtCO2 from 2019 to 2023.
• Only 35.3% of cases used EtCO2 for CPR monitoring during the same period.
• Median hospital proportion for airway confirmation was 94.0%, indicating consistency in practice.
• High variability was observed across hospitals for CPR monitoring with EtCO2.
• Low EtCO2 levels (<10 mmHg) during CPR are associated with unsuccessful resuscitation efforts.

Clinical Implications

Healthcare providers should ensure adherence to guidelines recommending EtCO2 for both airway confirmation and CPR monitoring. The observed variability in practice suggests a need for targeted interventions to improve the consistency of EtCO2 utilization across hospitals.

Conclusion

While EtCO2 is widely used for confirming airway placement during in-hospital cardiac arrest, there are significant gaps in its application for monitoring CPR quality. Addressing these gaps is essential for optimizing patient outcomes.

Related Resources & Content

1. American Heart Association, CPR & First Aid, 2025 -- Adult Advanced Life Support
2. European Resuscitation Council, 2025 -- Adult Advanced Life Support
3. Intensive Care Medicine, 2023 -- Relationship Between Prehospital End-Tidal Carbon Dioxide Measurements and Mortality Outcomes in Patients with Suspected Severe Traumatic Brain Injury
4. Intensive Care Medicine, 2023 -- Impact of Carbon Dioxide Levels on Clinical Outcomes in Patients with Acute Brain Injury Under Mechanical Ventilation
5. Intensive Care Medicine, 2018 -- Investigating Dual Modulation of Arterial Carbon Dioxide and Oxygen Levels Following Cardiac Arrest
6. Intensive Care Medicine — Assessment of Arterial Lactate and Venous-Arterial CO2 to Arterial-Venous O2 Content Ratio as Indicators of Resuscitation in Septic Shock Patients
7. Trends and Variation in Use of End-Tidal Carbon Dioxide During In-Hospital Cardiac Arrest
8. Part 9: Adult Advanced Life Support | American Heart Association CPR & First Aid
9. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support
10. Advanced Airway Devices and End-Tidal Capnography Trends in Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial | Emergency Medicine | JAMA Network Open | JAMA Network
11. Frontiers | A systematic review and meta-analysis of the association between arterial carbon dioxide tension and patient outcomes after cardiac arrest