Abstract
Objective
To evaluate the role of initial ETCO2 value in prognostication of OHCA patients in an Asian-Chinese cohort.
Design
Prospective cohort study.
Setting
Emergency departments of two regional hospitals in a cluster of Hong Kong.
Patients: Patients were recruited prospectively from the local cardiac arrest registry
from July 2012 to June 2013. Patients of non traumatic OHCA aged ≥18 years old were
included. Patients of OHCA presented with postmortem changes, those who decided for
Do Not Resuscitate (DNR), regained pulse before arrival, or those without proper documentation
of ETCO2 would be excluded.
Outcome
Primary outcome was return of spontaneous circulation (ROSC).
Results
A 3-min ETCO2 >10 mmHg was a predictor of ROSC with OR 18.16 (95% CI 4.79–51.32, p < 0.001). The diagnostic accuracy of 3-min ETCO2 >10 mmHg to predict ROSC: sensitivity was 0.95 (95% CI 0.89–0.98) while the specificity
was 0.27 (95% CI 0.21–0.33). Positive predictive value was 0.40 (95% CI 0.34–0.46)
while negative predictive value (NPV) was 0.92 (95% CI 0.82–0.97). Area under ROC
curve of 3-min ETCO2 predicting ROSC was 0.80 (95% CI 0.71–0.91).
Conclusions
A 3-min ETCO2 ≤10 mmHg was associated with poor prognosis and low chance of ROSC. Low ETCO2 level may have a role to reduce prolonged medically futile resuscitation.
Keywords
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References
- Electrocardiogram waveforms for monitoring effectiveness of chest compression during cardiopulmonary resuscitation.Crit Care Med. 2008; 36: 211-215
- The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation.Chest. 2007; 132: 70-75
- Effect of cardiopulmonary resuscitation compression rate on end-tidal carbon dioxide concentration and arterial pressure in man.Crit Care Med. 1988; 16: 241-245
- Utstein style analysis of out-of-hospital cardiac arrest- bystander CPR and end expired carbon dioxide.Resuscitation. 2007; 72: 404-414
- A sudden increase in partial pressure end-tidal carbon dioxide at the moment of return of spontaneous circulation.J Emerg Med. 2010; 38: 614-621
- End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest.N Engl J Med. 1997; 337 ([July 31]): 301-306
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).Resuscitation. 2004; 63: 233-249
- Medical futility.Neurocritical Care. 2005; 2: 198-205
- Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.Resuscitation. 2010; 81: 1479-1487
- Outcome of out-of-hospital cardiac arrest in a regional hospital in Hong Kong.Hong Kong J Emerg Med. 2005; 12: 224-227
- Predicting survival from out-of-hospital cardiac arrest: a multivariate analysis.Resuscitation. 1997; 34: 27-34
- “Event tree” analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR.Resuscitation. 2003; 56: 173-181
- Survival and outcome from prehospital cardiac arrest.Internet J Rescue Disaster Med. 2003; 4: 1-12
- Can changes in end-tidal PCO2 measure changes in cardiac output?.Anesth Analg. 1991; 73: 808-814
- Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output?.Anesth Analg. 1994; 79: 829-833
- End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation: a prognostic indicator for survival.JAMA. 1989; 262: 1347-1351
- Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration.Crit Care Med. 1990; 18: 358-362
- Clinical utility of a colorimetric end tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation.J Clin Monit. 1991; 7: 289-293
- End tidal carbon dioxide concentration during cardiopulmonary resuscitation.N Engl J Med. 1988; 318: 607-611
- Independent evaluation of an out-of-hospital termination of resuscitation (TOR) clinical decision rule.Acad Emerg Med. 2008; 15: 517-521
- End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation.JAMA. 1987; 257: 512-515
- Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132 ([Nov 3]): S444-S464
- Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators.Acad Emerg Med. 2002; 9: 671-678
- Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.N Engl J Med. 2006; 355: 478-487
- Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers.Resuscitation. 2007; 74: 266-275
- Prediction rules for estimating neurologic outcome following out-of-hospital cardiac arrest.Resuscitation. 2004; 63: 145-155
- Comparison of clinical prediction rules for termination of resuscitation of out-of-hospital cardiac arrests on arrival to emergency department.Hong Kong J Emerg Med. 2013; 20: 343-351
- The prognostic value of end-tidal carbon dioxide during cardiac arrest: a systematic review.Resuscitation. 2013; 84: 1470-1479
- Carbon dioxide elimination during circulatory arrest.Crit Care Med. 1987; 15: 944-946
Article info
Publication history
Published online: March 03, 2016
Accepted:
February 24,
2016
Received in revised form:
February 9,
2016
Received:
December 2,
2015
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.02.021.
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
