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End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients

      Abstract

      Aim

      To evaluate whether end-tidal carbon dioxide (ETCO2) value at intubation and its early increase (10 min) after intubation predict both the survival to hospital admission and the survival at hospital discharge, including good neurological outcome (CPC 1–2), in patients with out-of-hospital cardiac arrest (OHCA).

      Methods

      All consecutive OHCA patients of any etiology between 2015 and 2018 in Pavia Province (Italy) and Ticino Region (Switzerland) were considered. Patients died before ambulance arrival, with a “do-not-resuscitate” order, without ETCO2 value or with incomplete data were excluded.

      Results

      The study population consisted of 668 patients. An ETCO2 value at intubation > 20 mmHg and its increase 10 min after intubation were independent predictors (after correction for known predictors of OHCA outcome) of survival to hospital admission and survival at hospital discharge. Relative to hospital discharge with good neurological outcome, ETCO2 at intubation and its 10-min change were confirmed predictors both individually and in a bivariable analysis (OR 1.83, 95 %CI 1.02–3.3; p = 0.04 and OR 3.9, 95 %CI 1.97–7.74; p < 0.001, respectively). This was confirmed also when accounting for gender, age, etiology and location. After further adjustment for bystander and CPR status, presenting rhythm and EMS arrival time, the ETCO2 change remained an independent predictor.

      Conclusions

      ETCO2 value > 20 mmHg at intubation and its increase during resuscitation improve the prediction of survival at hospital discharge with good neurological outcome of OHCA patients. ETCO2 increase during resuscitation is a more powerful predictor than ETCO2 at intubation. A larger prospective study to confirm this finding appears warranted.

      Keywords

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      Linked Article

      • CPR capnography: It’s not where you’ve been, but where you’re going
        ResuscitationVol. 181
        • Preview
          Expired end-tidal carbon dioxide (ETCO2) capnography has been posited as a reliable non-invasive marker of the adequacy of cardiopulmonary resuscitation (CPR) since the mid-1980s.1 The prevailing theory is that adequate cardiac output generated by high-quality external chest compressions should produce ETCO2 levels approaching normal physiologic values, assuming no other impairments to gas exchange. In the setting of high-quality CPR, persistently low ETCO2 levels have been shown to be associated with poor survival, while higher ETCO2 levels (particularly if increasing during CPR) correlate with increased likelihood of return of spontaneous circulation (ROSC) and survival to hospital discharge.
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