Initial end-tidal CO 2 partial pressure predicts outcomes of in-hospital cardiac arrest

An-Yi Wang, Chien-Hua Huang, Wei-Tien Chang, Min-Shan Tsai, Chih-Hung Wang, Wen-Jone Chen
American Journal of Emergency Medicine 2016, 34 (12): 2367-2371

INTRODUCTION: Monitoring the partial pressure of end-tidal carbon dioxide (PEtco2 ) has been advocated since 2010 as an index of resuscitation efforts. However, related research has largely focused on out-of-hospital cardiac arrest victims. In-hospital cardiac arrest (IHCA) differs in terms of etiologies and demographics, the merit of initial PEtco2 values was explored.

METHODS: This was a retrospective study in a single medical center between February 2011 and August 2014. Eligible subjects had suffered nontraumatic IHCA in the emergency department, where resuscitation was performed in accord with 2010 American Heart Association guidelines. Patients with initial PEtco2 recordings via capnography were recruited.

RESULTS: A total of 353 IHCA events with initial PEtco2 were recorded in 202 patients (male, 61.4%; mean age, 67.0 ± 16.2 years). Shockable rhythm (ventricular tachycardia/ventricular fibrillation) accounted for 11.8%. A cut point of 25.5 mm Hg was established for initial PEtco2 , creating 2 tiers of sustained return of spontaneous circulation (ROSC) that differed significantly in cumulative survival probability (log rank test, P = .002). For patients with initial PEtco2 <25.5 mm Hg, survival benefit ceased at an earlier point in resuscitation, whereas above this threshold, the probability of survival cumulatively increased for a longer period. In multivariate analysis, initial PEtco2 >25.5 mm Hg was found independently predictive of sustained ROSC (odds ratio, 2.64; 95% confidence interval, 1.43-4.88; P = .002), and survival to discharge (odds ratio, 3.10; 95% confidence interval, 1.26-7.60; P = .014), but failed to correlate with neurologic outcome.

CONCLUSION: In IHCA, the therapeutic threshold for initial PEtco2 should set fairly higher to encourage more pulmonary flow and increase the likelihood of sustained ROSC.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"