(Resuscitation) Titrate Ventilations to keep high ETCO2 and ignore that SpO2 is in 40s?

[SterlingMaloryArcher]

I'm seeing a lot of resuscitations where the patient's are satting at 40% or less for 25-35 minutes. I'm told this is to keep their ETCO2 level high; but (and I'm only asking) it would make sense to initially titrate ventillations to raise SpO2 to a reasonable level to make up for the down-time. It seems to me that maintaining high ETCO2 and avoiding raising intrathoracic pressure is secondary because what's it matter if you do these things but have abysmal Oxygen Saturation the whole time?

Is 40% not as abysmal as I am thinking? For example, if you have a patient in V-tach which you can't break, why not try raising the oxygen as that's probably the underlying problem (It's my understanding v-tach is a hypoxic rhythm, so...)

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[Noisewater-TDX]

I haven't seen that done in the decade i've been in hospitals. I understand augmenting the ETCO2 to stimulating breathing (maybe) but it seems like the low SpO2 would continue to cause hypoxic injury and spiral them deeper into acidosis (and further cell damage).

Anytime we had someone in vtach we would pop them on a NRB mask at 15l, drug bolus amio - lido - other crap, and shock until they died or until we bounced them out of it.

Not unless there is new research that supports this method, I don't see a benefit??

 

[SterlingMaloryArcher]

I haven't seen that done in the decade i've been in hospitals. I understand augmenting the ETCO2 to stimulating breathing (maybe) but it seems like the low SpO2 would continue to cause hypoxic injury and spiral them deeper into acidosis (and further cell damage)1.

Anytime we had someone in vtach we would pop them on a NRB mask at 15l2, drug bolus amio - lido - other crap, and shock until they died or until we bounced them out of it.

Not unless there is new research that supports this method, I don't see a benefit??

1. Exactly my thoughts
2. They are not breathing, usually are intubated with an ETT or King Airway and being bagged if it makes a difference.

 

[Cryc_to_the_point]

If you've intubated them why not start working your way up the Fi02? Sometimes raising the head with mechanical CPR ongoing will improve recruitment (at least that's what I think I'm observing).

 

[Noisewater-TDX]

1. Exactly my thoughts
2. They are not breathing, usually are intubated with an ETT or King Airway and being bagged if it makes a difference.

True, lol. I was thinking about once in a blue moon awake and talking wide QRS tachycardia patient!