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End-Tidal Pco2 During Cardiopulmonary Resuscitation

Jack Yetiv, MD, PhD
JAMA. 1990;263(6):815. doi:10.1001/jama.1990.03440060054030.
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To the Editor.—  Sanders and colleagues1 recently showed that during cardiopulmonary resuscitation, an end-tidal PCO2 measurement of less than 10 mm Hg predicts a uniformly poor outcome (failure to resuscitate). They state that "there is an urgent need for a reliable method of assessing the efficacy of ongoing cardiopulmonary resuscitation." This suggests that end-tidal PCO2 was used to evaluate the hemodynamic efficacy of cardiopulmonary resuscitation, although the title and the article itself suggest that end-tidal PCO2 was studied as a prognostic indicator of the likely outcome of the resuscitation. Whereas a technique of assessing the efficacy of ongoing cardiopulmonary resuscitation may indeed be useful, a simple prognostic indicator already exists—namely, the presence of asystole or electromechanical dissociation as the underlying arrest rhythm.The data of Sanders et al show that only 1 of a total of 68 patients who presented with asystole or electromechanical dissociation survived


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