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Applications of End-Tidal Carbon Dioxide (ETCO2) Monitoring in Emergency Department; a Narrative Review

Hamed Aminiahidashti, Sajad Shafiee, Alieh Zamani Kiasari, Mohammad Sazgar




Capnograph is an indispensable tool for monitoring metabolic and respiratory function. In this study, the aim was to review the applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department, multiple databases were comprehensively searched with combination of following keywords: “ETCO2”, “emergency department monitoring”, and “critical monitoring” in PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and Cochrane Database.


Capnography; Emergency service, hospital; exhalation; carbon dioxide; monitoring, physiologic


O'Flaherty. Capnography: principles and practice. London: BMJ Publishing Group. 1994.

Smalhout B KZ. An atlas of capnography. Amsterdam: Kerchebosch-Zeist,. 1981.

M W. Respiratory monitoring: a ten year perspective. J Clin Monit. 1990;6:217-25

Block FE Jr MJ. Sidestream versus mainstream carbon dioxide analyzers. J Clin Monit. 1992;8(2):139-41.

Garey DM WR, Rich W, Heldt G, Leone T, Finer NN. T idal volume threshold for colorimetric carbon dioxide detectors available for use in neonates. Pediatrics ; 1. 2008;21(6):1524-7.

Berengo A C. Single-breath analysis of carbon dioxide concentration records. J Appl Physiol. 1961;16:522-30.

Falk JL RE, Weil MH. End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. N Engl7 Med 1989;318:607-11.

Garnett AR OJ, Gonzalez ER, Johnson EB. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. JAMA. 1987;257:512-5.

Ahrens T ea. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest

Am J Crit Care. 2001;10:391-8.

Ornato JP GE, Garnett AR, Levine RL, McClung BK. Effect of cardiopulmonary resuscitation compression rate on end-tidal carbon dioxide concentration and arterial pressure in man. Crit Care Med. 1988;16:241-5.

Cantineau JP ea. End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: A predictor of outcome. Crit Care Med. 1996;24:791-6.

Pokorná M AM, Necas E. End tidal CO2 monitoring in condition of constant ventilation: a useful guide during advanced cardiac life support. Prague Med Rep. 2006;107


Callaham M BC. Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med. 1990;18:358-62.

Cantineau JP MP, Lambert Y, Sorkine M, Bertrand C, Duvaldestin P. Effect of epinephrine on end-tidal carbon dioxide pressure during prehospital cardiopulmonary resuscitation. Am J Emerg Med. 1994;12:267- 70.

Levine RL WM, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med. 1997;337:301-6.

Cournoyer A, Iseppon M, Chauny JM, Denault A, Cossette S, Notebaert É. Near‐infrared Spectroscopy Monitoring During Cardiac Arrest: A Systematic Review and Meta‐analysis. Academic Emergency Medicine. 2016;23(8):851-62.

Ma G DD, Schmitt J, Vilke GM, Chan TC, Hayden SR. the sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a cadaver model. J Emerg Med. 2007 32(4):405-7.

Turle S SP, Nicholson S, Callaghan T, Shepherd SJ. Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom. Resuscitation. 2015 94:80-4.

Š G. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med. 2002;28:701-4.

Goldberg JS RP, Zehnder JL, Sladen RN. Colorimetric end-tidal carbon dioxide monitoring for tracheal intubation. Anesth Analg. 1990 70(2):191-4.

Garnett AR GC, Gervin AS. Capnographic waveforms in esophageal intubation: Effect of carbonated beverages. Ann Emerg Med. 1989;18:387-90.

Okamoto H HS, Kawasaki T, Okuyama T, Takahashi S. Changes in end-tidal carbon dioxide tension following sodium bicarbonate administration: Correlation with cardiac output and haemoglobin concentration. Acta Anaesthesiol Scand 1995;39:79-84.

B K. Capnography as a rapid assessment and triage tool for chemical terrorism. Pediatr Emerg Care. 2005;21:493-7.

Adams L BS, Spurlock D Jr. Capnography (ETCO2), respiratory depression, and nursing interventions in moderately sedated adults undergoing transesophageal echocardiography (TEE). J Perianesth Nurs. 2015 30(1):14-22.

Mora Capín A MNC, López López R, Marañón Pardillo R. Usefulness of capnography for monitoring sedoanalgesia: influence of oxygen on the parameters monitored. An Pediatr (Barc). 2014;80(1):41-6.

Burton JH HJ, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med. 2006;13(500-504).

Deitch K MJ, Chudnofsky CR, Dominici P, Latta D. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Ann Emerg Med. 2010;55(258-264).

Soto RG FE, Vila H Jr, Miguel RV. Capnography accurately detects apnea during monitored anesthesia care. Anesth Analg. 2004;99:379-82.

Hawkins NM PM, Pardeep SJ, et al. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Failure. 2009;11:130-9.

Corbo J BP, Lahn M, et al. Concordance between capnography and arterial blood gas measurements of carbon dioxide in acute asthma. Ann Emerg Med. 2005;46(323-327).

Cinar O AY, Arziman I, et al. Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED. Am J Emerg Med. 2012;30(358-361).

Krauss B ea. Capnogram shape in obstructive lung disease. Anesth Analg. 2005;100:884-8.

Krauss B HD. Capnography for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007;50:172-81.

Yaron M PP, Hutsinpiller M, Cairns CB. Utility of the expiratory capnogram in the assessment of bronchospasm. Ann Emerg Med. 1996;28:403-7.

Doğan NÖ ŞA, Günaydın GP, İçme F, Çelik GK, Kavaklı HŞ, Temrel TA. T. he accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED. Am J Emerg Med. 2014 32(5):408-11.

Anderson C T BPH. Carbon dioxide kinetics and capnography during critical care. Crit Care Med. 2000;4:207-15.

Taniguchi S IK, Sakaguchi Y. et al. Capnometry as a tool to unmask silent pulmonary embolism. Tohoku J Exp Med. 1997;183(4):263-71.

Verschuren F HE, Clause D, Roeseler J, Thys F, Meert P, Marion E, El Gariani A, Col J, Reynaert M, Liistro G. Volumetric capnography as a bedside monitoring of thrombolysis in major pulmonary embolism. Intensive Care Med. 2004 30(11):2129-32.

Kline JA HM. Measurement of expired carbon dioxide, oxygen and volume in conjunction with pretest probability estimation as a method to diagnose and exclude pulmonary venous thromboembolism. Clin Physiol Funct Imaging. 2006 26(4):212-9.

Stiell IG SD, Field B, Nesbitt LP, Munkley D, Maloney J, Dreyer J, Toohey LL, Campeau T, Dagnone E, Lyver M, Wells GA. OPALS Study Group. Advanced life support for out-of-hospital respiratory distress. N Engl J Med. 2007;356(21):2156-64.

Macchia A MS, Romero M, D'Ettorre A, Tognoni G. The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure. Eur J Heart Fail. 2007;9(9):942-8.

Brown LH GJ, Seim RH. Can quantitative capnometry differentiate between cardiac and obstructive causes of respiratory distress? Chest. 1998;113(2):323-6.

Grmec Š GM, Klemen P, Cander D. Utility of the quantitative capnometry (QC) and rapid bedside test for N-terminal pro-brain natriuretic peptide (pro-BNP) in the evaluation of respiratory distress in prehospital setting - preliminary results. J Emerg Med. 2007;33(3):322.

Arena R GM, Myers J. Prognostic value of end-tidal carbon dioxide during exercise testing in heart failure. Int J Cardiol. 2007;117(1):103-8.

Arena R GM, Myers J, Chase P, Bensimhon D, Cahalin LP, Peberdy MA, Ashley E, West E, Forman. Prognostic value of capnography during rest and exercise in patients with heart failure. Congest Heart Fail. 2012;18(6):230-307.

Klemen P GM, Grmec S. Combination of quantitative capnometry, N-terminal pro-brain natriuretic peptide, and clinical assessment in differentiating acute heart failure from pulmonary disease as cause of acute dyspnea in pre-hospital emergency setting: study of diagnostic accuracy. Croat Med J. 2009 50(2):133-42.

Emanuel RM P, Bryant Nguyenn H. A Comprehensive Study Guide. In Emergency Medicine. Tintinalli JE KG SJ, editor. New York: McGraw-Hill, Inc; 2004.

Weil MH NY, Tang W, Sato Y, Ercoli F, Finegan R, Grayman G, Bisera J. Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med. 1999 27(7):1225-9.

Rackow EC ONP, Astiz ME, Carpati CM. S. ublingual capnometry and indexes of tissue perfusion in patients with circulatory failure. Chest. 2001;120(5):1633-88.

Hemnes AR NA, Rosenbaum B, Barrett TW, Zhou C, Rice TW, Newman JH. Bedside end tidal CO2 as a screening tool to exclude pulmonary embolism. EurRespir J. 2010;35(4):735-41.

Kheng CP RN. The use of end-tidal carbon dioxide monitoring in patients with hypotension in the emergency department. International Journal of Emergency Medicine. 2012;5(1):31.

DMello J BM. Capnography. Indian J Anesth. 2002;46(4):269-78.

Syed Shujat A AD, Abdul Raheem al Gattan. The relationship between end tidal carboon dioxide and urterial carbon dioxide during controlled hypotensice anesthesia. Med principles pact. 2002;11:35-7.

Mahoori A HE, Mehdizadeh H, and Nanbakhsh N. the effects of blood pressure variations on end-tidal and arterial CO2 pressure differences in patients undergoing coronary artery bypass graft. Journal of Iranian Society of Anesthesiology and Intensive Care. 2014;36(85):3-9.

Yang HW, Jeon W, Min YG, Lee JS. Usefulness of end-tidal carbon dioxide as an indicator of dehydration in pediatric emergency departments: A retrospective observational study. Medicine. 2017;96(35).

BS K. Capnography outside the operating rooms. Anesthesiology. 2013;118:192-201.

Rafael O CC, Sora K, et al. Monitoring Ventilation with Capnography. N Eng J Med. 2012;367.

Pishbin E AG, Sharifi MD, Deloei MT, Shamloo AS, Reihani H. The correlation between end-tidal carbon dioxide and arterial blood gas parameters in patients evaluated for metabolic acid-base disorders. Electron Physician. 2015;7(3):1095-101.

Kartal M EO, Rinnert S, Goksu E, Bektas F, Eken C. ETCO₂. a predictive tool for excluding metabolic disturbances in nonintubated patients. Am J Emerg Med. 2011;29(1):65-9.

Taghizadieh A, Pouraghaei M, Moharamzadeh P, Ala A, Rahmani F, Sofiani KB. Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine. Journal of cardiovascular and thoracic research. 2016;8(3):98.

Losman ED. Weakness. In: A MJ, editor. Rosen’s Emergency Medicine. 87-92. Philadelphia: Mosby; 2010.

Fearon DM SD. End-tidal carbon dioxide predicts the presence and severity of acidosis in children with diabetes. Acad Emerg Med. 2002 9(12):1373-8.

Soleimanpour H TA, Niafar M, Rahmani F, Golzari SE, Esfanjani RM. Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department. West J Emerg Med. 2013;14(6):590-4.

Glaser NS BP, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med. 2001;344:264-9.

Chebl RB, Madden B, Belsky J, Harmouche E, Yessayan L. Diagnostic value of end tidal capnography in patients with hyperglycemia in the emergency department. BMC emergency medicine. 2016;16(1):7.

Nagler J WR, Krauss B. End-tidal carbon dioxide as a measure of acidosis among children with gastroenteritis. Pediatrics ; 1. 2006 118(1):260-7.

Williams DJ, Guirgis FW, Morrissey TK, Wilkerson J, Wears RL, Kalynych C, et al. End-tidal carbon dioxide and occult injury in trauma patients: ETCO2 does not rule out severe injury. The American journal of emergency medicine. 2016;34(11):2146-9.

Childress K, Arnold K, Hunter C, Ralls G, Papa L, Silvestri S. Prehospital End-tidal Carbon Dioxide Predicts Mortality in Trauma Patients. Prehospital Emergency Care. 2017:1-5.

Stone ME, Kalata S, Liveris A, Adorno Z, Yellin S, Chao E, et al. End-tidal CO 2 on admission is associated with hemorrhagic shock and predicts the need for massive transfusion as defined by the critical administration threshold: A pilot study. Injury. 2017;48(1):51-7.

DOI: https://doi.org/10.22037/emergency.v6i1.19298


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