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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Article info
Publication history
Published online: June 20, 2022
Accepted:
June 15,
2022
Received in revised form:
June 13,
2022
Received:
April 26,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
