Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field - a prospective observational study

Miran Kolar (Author), Miljenko Križmarić (Author), Petra Klemen (Author), Štefek Grmec (Author)

Abstract

Introduction. The prognosis among patients who suffer out-of-hospital cardiac arrest is poor. Higher survival rates have been observed only in patients with ventricular fibrillation who were fortunate enough to have basic and advanced life support initiated early after cardiac arrest. The ability to predict outcomes of cardiac arrest would be useful for resuscitation. Changes in expired end-tidal carbon dioxide levels during cardiopulmonary resuscitation may be a useful non-invasive predictor of successful resuscitation and survival from cardiac arrest, and help in the termination of cardiopulmonary resuscitation in the field. Methods. This is a prospective observational study of 737 cases of victims who suffered sudden out-of-hospital cardiac arrest. The patients were intubated and the measurements of end-tidal carbon dioxide were performed. Data according to the Utstein criteria, demographic information, medical data and partial pressure of end-tidal carbon dioxide (petCO2) values were collected for each patient in cardiac arrest, by the emergency physician. We presumed that an end-tidal carbon dioxide level of 1.9 kPa (14.3 mmHg) or more after 20 minutes of standard advanced cardiac life support would predict restoration of spontaneous circulation (ROSC). Results. Partial pressure of end-tidal carbon dioxide after 20 minutes of advanced life support averaged 0.92+/- 0.29 kPa (6.9mmHg +/- 2.2 mmHg) in patients who did not have ROSC and 4.36 +/-1.11 kPa (32.8 mmHg +/- 9.1 mmHg) in those who did (p<0,001). End-tidal carbon dioxide values of 1.9 kPa (14.3 mmHg) or less discriminated between the 402 patients with ROSC and 335 patients without ROSC. When a 20-minute end-tidal carbon dioxide value of 1.9 kPa (14.3 mmHg) or less was used as a screening test to predict ROSC, the sensitivity, specificity, positive predictive value, and negative predictive value were all 100 percent. Conclusions. Measurements of end-tidal carbon dioxide levels of more than 1.9 kPa (14.3 mmHg) after 20 minutes should be used to accurately predict ROSC. End-tidal carbon dioxide levels should be monitored during cardiopulmonary resuscitation and considered a useful prognostic value for determining the outcome of resuscitative efforts and termination of cardio-pulmonary resuscitation in the field.

Keywords

out-of-hospital cardiac arrest;cardiopulmonary resuscitation;CPR;partial pressure of end-tidal carbon dioxide;PetCO2;

Data

Language:	English
Year of publishing:	2008
Typology:	1.01 - Original Scientific Article
Organization:	UM FZV - Faculty of Health Sciences
UDC:	616-083.98
COBISS:	3030847
ISSN:	1466-609X
Views:	1251
Downloads:	116
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	Slovenian
Secondary keywords:	Heart Arrest;Srčni zastoj;Ventricular Fibrillation;Ventrikularna fibrilacija;Cardiopulmonary Resuscitation;Kardiopulmonalno oživljanje;Carbon Dioxide;Ogljikov dioksid;Survival Rate;Stopnja preživetja;
URN:	URN:SI:UM:
Type (COBISS):	Scientific work
Pages:	str. R115 [1-13]
Volume:	ǂVol. ǂ12
Issue:	ǂno. ǂ5
Chronology:	2008
DOI:	10.1186/cc7009
ID:	10845023