Chest compressions induce errors in end-tidal carbon dioxide measurement

Mikel Leturiondo, Sofía Ruiz de Gauna, José Julio Gutiérrez, Daniel Alonso, Carlos Corcuera, Juan Francisco Urtusagasti, Digna María González-Otero, James Knox Russell, Mohamud Ramzan Daya, Jesus María Ruiz

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Real-time measurement of end-tidal carbon dioxide (ETCO2) is used as a non-invasive estimate of cardiac output and perfusion during cardiopulmonary resuscitation (CPR). However, capnograms are often distorted by chest compressions (CCs) and this may affect ETCO2 measurement. The aim of the study was to quantify the effect of CC-artefact on the accuracy of ETCO2 measurements obtained during out-of-hospital manual CPR. Methods: We retrospectively analysed monitor-defibrillator recordings collected by two advanced life support agencies during out-of-hospital cardiac arrest. These two agencies, represented as A and B used different side-stream capnometers and monitor-defibrillators. One-minute capnogram segments were reviewed. Each ventilation within each segment was identified using the transthoracic impedance signal and the capnogram. ETCO2 values per ventilation were manually annotated and compared to the corresponding capnometry values stored in the monitor-defibrillator. Ventilations were classified as distorted or non-distorted by CC-artefact. Results: A total of 407 1-min capnogram segments from 65 patients were analysed. Overall, 4095 ventilations were annotated, 2170 (32.4% distorted) and 1925 (31.8% distorted) for agency A and B, respectively. Median (IQR) unsigned error in ETCO2 measurement increased from 1.5 (0.6–3.1)% for non-distorted to 5.5 (1.8–14.1)% for distorted ventilations; from 0.7 (0.3–1.2)% to 3.7 (1.0–9.9)% in agency A and from 2.3 (1.2–3.9)% to 8.3 (3.9–19.5)% in agency B (p < 0.001). Errors were higher than 10 mmHg in 9% and higher than 15 mmHg in 5% of the distorted ventilations. Conclusion: CC-artefact causes ETCO2 measurement errors in the two studied devices. This suggests that capnometer algorithms may need to be adapted to reliably perform in the presence of CC-artefact during CPR.

Original languageEnglish (US)
Pages (from-to)195-201
Number of pages7
StatePublished - Aug 2020


  • Advanced life support
  • Capnometry
  • Cardiopulmonary resuscitation
  • Chest compressions
  • End-tidal CO2
  • Ventilations
  • Waveform capnography

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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