Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations

Abstract

Background: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation.

Objective of the review: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms.

Discussion: Capnography includes the noninvasive measurement of CO₂, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO₂ present. Quantitative capnography provides a numeric value (end-tidal CO₂), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment.

Conclusions: Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment.

Keywords: capnography; capnometer; carbon dioxide; end-tidal; monitoring; resuscitation; waveform.