The 2020 AHA Guidelines for ACLS recommend using quantitative waveform capnography in intubated patients during CPR. Waveform capnography allows providers to monitor CPR quality by optimizing chest compressions and can be used as a tool to help detect ROSC (return of spontaneous circulation) during CPR.

Two very practical applications of waveform capnography in CPR are:

1. Evaluating the effectiveness of chest compressions Measurement of a low EtCO2 value (<10 mmHg) during CPR in an intubated patient may indicate that the quality of chest compressions needs improvement.  High quality chest compressions are achieved when the EtCO2 value is at least 10-12 mmHg.  If EtCO2 is less than 10 mmHg, determine if provider fatigue is occurring.

2. Assistance with the identification of ROSC When ROSC occurs, there will be a significant increase in EtCO2 (~35-45 mmHg) which indicates a dramatic increase in cardiac output resulting in increased perfusion. The CO2 that accumulated during the cardiac arrest is now being transported to the lungs, is exhaled, and is measured by the EtCO2 detector.

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