Abrupt rise of end tidal carbon dioxide level was a specific but non-sensitive marker of return of spontaneous circulation in patient with out-of-hospital cardiac arrest

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.

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End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2017.09.010 ◽

2017 ◽

Vol 121 ◽

pp. 71-75 ◽

Cited By ~ 6

Author(s):

Simone Savastano ◽

Enrico Baldi ◽

Maurizio Raimondi ◽

Alessandra Palo ◽

Mirko Belliato ◽

...

Keyword(s):

Carbon Dioxide ◽

Cardiac Arrest ◽

End Tidal Carbon Dioxide ◽

End Tidal ◽

Hospital Cardiac Arrest

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Can an initial end-tidal CO2 <1.33 kPa predict lack of return of spontaneous circulation during pre-hospital cardiac arrest?

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-22-s1-o5 ◽

2014 ◽

Vol 22 (S1) ◽

Author(s):

Leif Rognås ◽

Troels Martin Hansen ◽

Hans Kirkegaard ◽

Else Tønnesen

Keyword(s):

Cardiac Arrest ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11006376 ◽

2011 ◽

Vol 26 (3) ◽

pp. 148-150 ◽

Cited By ~ 34

Author(s):

Marc Eckstein ◽

Lorien Hatch ◽

Jennifer Malleck ◽

Christian McClung ◽

Sean O. Henderson

Keyword(s):

Cardiac Arrest ◽

Los Angeles ◽

Spontaneous Circulation ◽

Outcome Variable ◽

Primary Outcome Variable ◽

Return Of Spontaneous Circulation ◽

Bystander Cardiopulmonary Resuscitation ◽

The Mean ◽

End Tidal ◽

Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

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