cap-ONE Information

Vol.4

Improve Manual Ventilation andCPR with ETCO2 Audible Cue
Hear the ETCO2 level - ETCO2 information without needing to look at the monitor ETCO2 Audible Cue helps the caregivermanage ETCO2 during manual ventilation
and CPR by delivering 5 different, easily
recognizable sounds to indicate 5 ranges
from high to low ETCO2. Audible Cue
provides the caregiver with instant feedback
about ETCO2 level changes – without
needing to look at the monitor.

High

CO2 (mmHg)

60NormalLow1

40

Low2

Low3200≥ 45 mmHg*

35 - 44 mmHg*

20 - 34 mmHg*

10 - 19 mmHg*≤ 9 mmHg** ETCO2 range for each pitch can be adjusted to suit your needs

Enhanced control of manual ventilation during patient transport
Manual ventilation during interhospital transport is a vital procedure for patients who require ventilatory support.
However, manual ventilation is technically demanding, requires high skill and training, and it is not always easy for evenexperienced professional caregivers to ventilate patients.
It has been shown that Audible Cue can be an efficient way to enable tighter control of ETCO2 within the target range
when performing manual ventilation during patient transport. The following figure shows the results of a study comparing
manual ventilation with no capnometric monitoring and with capnometric monitoring with and without Audible Cue.1

No monitoring
provided

Conventional
capnography

Capnography+
Audible Cue

Hyperventilation

Mild hyperventilation

Appropriate ventilation

Comparison of control of ETCO2 during manual ventilation
In a pilot study, 10 anesthesia trainees manually ventilated the simulator while transporting the stretcher for 5 minutes without any monitoring
provided. Conventional capnography and conventional capnography with Audible Cue were also used. In the absence of capnometry monitoring
information, the trainees tended to ventilate too aggressively. Use of conventional capnometry slightly improved the control of ETCO2 but stilltended towards hyperventilation. The addition of Audible Cue to conventional capnometric information enhanced the control of ETCO2 during
manual ventilation. (from Reference 1, used with permission)cap-ONE Information Vol.4

More effective ETCO2 monitoring in CPR

According to International Liaison Committee on Resuscitation (ILCOR)2 and international guidelines including AHA3 andERC4, continuous waveform capnography is recommended in addition to clinical assessment as a reliable method to confirm
and monitor correct placement of endotracheal tube, CPR quality and to provide an early indication of return of spontaneous
circulation (ROSC). It is also recommended that if ETCO2 is lower than 10 mmHg, attempt to improve CPR quality should
be considered. It is anticipated that addition of audible signals to the conventional capnometric information (numeric andwaveform) could facilitate the confirmation of the quality of CPR and improve the quality of patient monitoring.

5 Audible Cue ranges: Rising and falling pitch indicates ETCO2 level in manual ventilation and CPR
The Audible Cue consists of 2 or 3 sounds. The higher or lower pitch of the second sound indicates whether the ETCO2 levelis higher or lower than the normal (optimal) level.
The Audible Cue sounds are also different and easy to distinguish from other sounds such as heart rate sync. The exact
ETCO2 range is instantly recognizable by 5 different patterns.
Primarily
designed for

ETCO2 range*[mmHg]

Audible Cuesound typeHighAudible Cue sound designHigh45 ≤(High)Low≥ 45 mmHg*

Manualventilation
and ROSC
confirmation

NormalExample of situation

・Hypoventilation is caused by insufficient manual
ventilation during transport
・ROSC is achived*

High35 - 44(Normal)

Ventilation is sufficient
35 - 44 mmHg*

Low
High

20 - 34(Low 1)

Hyperventilation is caused by over aggressive
manual ventilation during transport

Low1

20 - 34 mmHg*

Low
High

CPR (chestcompression)

10 - 19(Low 2)

Low2

10 - 19mmHg*

High quality chest compressions are achieved
LowHigh≤9(Low 3)

Quality of effectiveness of chest compression
may need improvement

Low3≤ 9 mmHg*

Low*ROSC may be detected in ETCO2 range lower than 45 ≤The upper 3 ranges (High, Normal, and Low) are especially designed to optimize manual ventilation and to detect ROSC.
Audible Cue provides the caregiver with instant feedback if he or she is optimally ventilating the patient and if ROSC is achieved.
The lower 2 levels (Low 2 and Low 3) are especially designed to optimize CPR quality. These Audible Cue alerts the caregiverof extremely low ETCO2 so he or she can immediately improve the CPR quality according to the AHA guidelines.

References

Audible Cue is available on OLG-3800

8869

SP66-0023A ’16.11. SE. A.

1 M
 iyasaka K et al. Audible capnometric cues facilitate targeted control of end-tidal carbon dioxideduring manual ventilation. Annual meeting of American Society of Anesthesiologists. 2013;A1185.
2 C
 allaway CW et al. Part 4: Advanced Life Support: 2015 International Consensus on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations. Circulation. 2015 Oct 20;132(16 Suppl 1):S84-145
3 L ink MS et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association
Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Circulation. 2015 Nov 3;132(18 Suppl 2):S444-64
4 S oar J et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult
advanced life support. Resuscitation, October 2015, Pages 100 - 147