Expanding End-Tidal Carbon Dioxide (EtCO2) Monitoring in Battlefield Medicine: A Call for Standardization, Research, and Innovation.

Abstract

End-tidal carbon dioxide (EtCO2) monitoring provides critical physiologic data reflecting both ventilation and perfusion status in trauma patients. Despite robust evidence demonstrating its predictive value for hemorrhagic shock, massive transfusion, and mortality, EtCO2 remains underutilized in prehospital and battlefield care, particularly for spontaneously breathing casualties. This article reviews current utilization patterns, summarizes clinical evidence supporting expanded use, presents an operational case study from recent combat, and proposes a prototype system for austere environments. Further studies are indicated regarding standardization of EtCO2 monitoring for battlefield casualties, as outcome data may drive innovation in lightweight monitoring technology and possible integration into TCCC protocols.