Reference — Emergency Respiratory Care
Code Blue: The RT’s Role
A bedside reference for the respiratory therapist in an adult cardiac arrest — high-quality CPR metrics, compression-to-ventilation ratios with and without an advanced airway, the capnography targets that track CPR quality and ROSC, and the reversible causes (the H’s and T’s). Real resuscitation follows current ACLS algorithms and local protocol.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
When the code is called, the RT owns the airway and ventilation and helps the team keep compressions high-quality. This reference puts the numbers in one place. Real resuscitation follows current ACLS algorithms and local protocol, and care is delivered under physician orders.
High-Quality CPR
| Parameter | Target |
|---|---|
| Compression rate | 100 – 120 /min |
| Compression depth (adult) | at least 2 in (5 cm), no more than 2.4 in (6 cm) |
| Recoil | full chest recoil between compressions |
| Chest compression fraction | greater than 60% (minimize interruptions) |
| Compressor rotation | every 2 minutes (or sooner if fatigued) |
Ventilation
| Situation | Ventilation |
|---|---|
| No advanced airway | 30:2 compression-to-ventilation (2 breaths each cycle) |
| With advanced airway (ETT or supraglottic) | continuous compressions + 1 breath every 6 seconds (10/min), asynchronous |
| Each breath | about 1 second, just enough for visible chest rise; 100% oxygen |
| Avoid | hyperventilation (raises intrathoracic pressure, lowers venous return and survival) |
Capnography (EtCO₂) in the Code
| Use | Interpretation |
|---|---|
| Tube confirmation | a sustained waveform confirms endotracheal tube placement (the most reliable confirmation) |
| CPR quality | EtCO₂ reflects pulmonary blood flow; persistently under 10 mmHg suggests inadequate compressions |
| ROSC | an abrupt rise in EtCO₂ (often above 35 – 40 mmHg) signals return of circulation |
Reversible Causes (the H’s and T’s)
| H’s | T’s |
|---|---|
| Hypovolemia | Tension pneumothorax |
| Hypoxia | Tamponade (cardiac) |
| Hydrogen ion (acidosis) | Toxins |
| Hypo-/hyperkalemia | Thrombosis, pulmonary (PE) |
| Hypothermia | Thrombosis, coronary (MI) |
Clinical Notes
- The RT’s two highest-value contributions. Never hyperventilate, and use continuous waveform capnography to confirm the tube, gauge CPR quality, and catch ROSC.
- Minimize pauses in compressions. Intubate without stopping CPR when possible — every pause in compressions costs perfusion pressure.
- Post-ROSC management. Titrate FiO₂ to SpO₂ 92 – 98% (avoid hyperoxia), target normocapnia (avoid hyperventilation), and support targeted temperature management.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Cardiopulmonary resuscitation and emergency cardiac care chapters.
- Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.