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A A A  ETCO2 represents the partial pressure or maximal concentration of CO2 at the end of exhalation. A A A  The third stage is where the buffer action of hemoglobin and pulmonary blood flow maintain the normal level of CO2 tension by eliminating the excess CO2.
A A A  The fourth stage involves CO2 elimination by alveolar ventilation under the control of the respiratory center. During acutely low cardiac output state as in cardiac arrest, decreased pulmonary blood flow becomes the primary determinant resulting in abrupt decrease of ETCO2. A A A  One way of measuring ETCO2 is with the infrared capnometer, which contains a source of infrared radiation, a chamber containing the gas sample, and a photodetector.
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As the intracellular CO2 increases, CO2 diffuses out into the tissue capillaries and is carried by the venous circulation to the lungs, where it diffuses from pulmonary capillaries into the alveoli. This process allows the diffusion of CO2 from blood to the alveoli where the partial alveolar pressure of CO2 is lower than the tissue pressure. Changes in alveolar ventilation can also influence ETCO2 as PACO2 closely approximates PaCO2 and ETCO2.
When the expired CO2 passes between the beam of infrared light and photodetector, the absorbence is proportional to the concentration of CO2 in the gas sample. CO2 reflects cardiac output (CO) and pulmonary blood flow as the gas is transported by the venous system to the right side of the heart and then pumped to the lungs by the right ventricles.
The hydrogen ions are buffered by hemoglobin, and the bicarbonate ions are transported into the blood. If ventilation and chest compressions are constant with the assumption that CO2 production is uniform, then the change in ETCO2 reflects the changes in systemic and pulmonary blood flow.

The gas samples can be analyzed by the mainstream (in-line) or sidestream (diverting) techniques. When CO2 diffuses out of the lungs into the exhaled air, a device called capnometer measures the partial pressure or maximal concentration of CO2 at the end of exhalation. The pressure difference of 5 mmHg will cause all the required CO2 to diffuse out of pulmonary capillaries into the alveoli.
Ultimately, ETCO2 can be used as a quantitative index of evaluating adequacy of ventilation and pulmonary blood flow during CPR. During CPR, the amount of CO2 excreted by the lungs is proportional to the amount of pulmonary blood flow.

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