Introduction:
Based on laboratory CPR investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating end-tidal carbon dioxide (ETCO2) to > 20 mmHg during CPR.
Hypothesis:
ETCO2 > 20 mmHg during pediatric in-hospital CPR is associated with survival to hospital discharge.
Methods:
Children > 37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for > 1 minute and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. ETCO2 and Utstein-style cardiac arrest data were collected. Multivariable Poisson regression models with robust error estimates were used to estimate relative risk of outcomes.
Results:
Investigators blinded to outcome analyzed ETCO2 waveforms from 43 children for the first (up to) 10 minutes of CPR. During CPR, the median ETCO2 was 23 mmHg (quartiles, 16 and 28 mmHg), median ventilation rate was 29 breaths/minute (quartiles, 24 and 35 bpm), and median duration of CPR was 5 minutes [quartiles, 2 and 16 minutes]. Return of spontaneous circulation occurred after 71% of CPR events and 37% of patients survived to hospital discharge. For children with mean ETCO2 during CPR > 20 mmHg, the adjusted relative risk for return of spontaneous circulation was 1.32 (0.89, 1.95), p= 0.16 and for survival to hospital discharge was 0.92 (0.41, 2.08), p= 0.84. Further sensitivity analyses were unable to demonstrate an association between mean ETCO2 > 25 mmHg or > 30 mmHg and ROSC or survival to hospital discharge. The median mean ETCO2 among children who survived to hospital discharge was 20 mmHg [quartiles; 15, 28 mmHg] versus 23 mmHg [16, 28 mmHg] among non-survivors.
Conclusion:
Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with ROSC or survival to hospital discharge. ETCO2 was not demonstrably different among survivors versus non-survivors.
End-tidal carbon dioxide monitoring may be associated with a higher possibility of return of spontaneous circulation during out-of-hospital cardiac arrest: a population-based study
