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Clinical paper| Volume 177, P28-37, August 2022

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Association between trajectories of end-tidal carbon dioxide and return of spontaneous circulation among emergency department patients with out-of-hospital cardiac arrest

  • Chih-Hung Wang
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Tsung-Chien Lu
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Joyce Tay
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Cheng-Yi Wu
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Meng-Che Wu
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Kah-Meng Chong
    Affiliations
    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Eric H Chou
    Affiliations
    Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX, USA

    Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX, USA
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  • Chu-Lin Tsai
    Correspondence
    Corresponding author at: No.7, Zhongshan S. Rd., Taipei City 100, Taiwan.
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Chien-Hua Huang
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Matthew Huei-Ming Ma
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan, Taiwan
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  • Wen-Jone Chen
    Affiliations
    Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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      Abstract

      Background

      We aimed to identify distinct trajectories of end-tidal carbon dioxide (EtCO2) during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) and to investigate the association between EtCO2 trajectories and OHCA outcomes.

      Methods

      This was a secondary analysis of a prospectively collected database on adult patients with OHCA who had been resuscitated in the emergency department of a tertiary medical center between 2015 and 2020. The primary outcome was the return of spontaneous circulation (ROSC). Group-based trajectory modelling was used to identify the EtCO2 trajectories. Multivariable logistic regression analysis was performed to evaluate the association between EtCO2 trajectories and ROSC. The predictive performance of the EtCO2 trajectories was assessed using the area under the receiver operating characteristic curve (AUC).

      Results

      The study comprised 655 patients with OHCA. In the primary analysis, three distinct EtCO2 trajectories, including 10-mmHg, 30-mmHg, and 50-mmHg trajectories, were identified. Compared with the 10-mmHg trajectory, both 30-mmHg (odds ratio [OR]: 4.66, 95% confidence interval [CI]: 3.15–6.90) and 50-mmHg (OR: 7.58, 95% CI: 4.30–13.35) trajectories were associated with a higher likelihood of ROSC. In a sensitivity analysis of excluding EtCO2 measured before tracheal intubation or after sodium bicarbonate administration, the predictive ability of the identified EtCO2 trajectories remained. As a single predictor of ROSC, EtCO2 trajectories had an acceptable discriminative performance (AUC: 0.69, 95% CI: 0.66–0.73).

      Conclusion

      Three distinct EtCO2 trajectories during cardiopulmonary resuscitation were identified and significantly associated with outcomes. Early identification of these EtCO2 trajectories could potentially guide the ongoing resuscitation efforts.

      Keywords

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