Using Initial End-tidal Carbon Dioxide Level to Predict the Outcome of In-Hospital Cardiac Arrest
Date Issued
2015
Date
2015
Author(s)
Wang, An-Yi
Abstract
Background Partial pressure of end-tidal carbon dioxide (PEtCO2) had been recommended to guide the quality of resuscitation since 2010. However, there is no consensus about the specific cut-off value of initial PEtCO2 in discrimination of prognosis and it could not be considered as the only determination rule. Most of the researches focused on the out-of hospital cardiac arrest (OHCA) victims, since the etiology and demographic characteristics of in-hospital cardiac arrest (IHCA) was different. Our research focus on explore the prognostic value of initial PEtCO2 in IHCA. Methods This is a retrospective study from February, 2011 to August, 2014 in National Taiwan University Hospital. We collect patient suffered from non-traumatic IHCA in emergency department receiving resuscitation followed with 2010 American Heart Association guidelines for resuscitation. We collect IHCA using capnography with initial PEtCO2 recorded, and these data were retrospectively reviewed followed the Utstein data and together with other clinical information. Results In 43 months study period, there was total 353 IHCA events, and 202 events with initial PEtCO2 level recorded were included. 61.4 % was male and the mean age was 67.0±16.2 years old. Shockable rhythm accounts 11.8%. The mean recorded time was 7.2±5.5 minutes since resuscitation. The cut-off value of initial PEtCO2 is defined as 25.5 mmHg distinguished between sustained ROSC or not. The cumulative survival probability of sustained ROSC showed significant difference at initial PEtCO2 25.5 mmHg (log rank test, p=0.002). In multivariate analysis, initial PEtCO2 higher than 25.5mmHg was an independent predictive factor for any ROSC(Odds ratio=3.12;95% CI[1.56-6.26],p=0.001)、sustained ROSC (Odds ratio=2.64;95% CI [1.43-4.88], p=0.002) and survival to discharge (Odds ratio =3.10; 95% CI [1.26-7.60], p=0.014). Initial PEtCO2 did not correlated with neurologic outcome. In subgroup analysis, initial PEtCO2 level did not have significant difference between shockable and non-shockable rhythm. Moderate positive correlation between initial PEtCO2 and pressure of CO2 in blood was also observed (r=0.420, p<0.001). Conclusions In our study, to improve the likelihood of ROSC in IHCA, the threshold of PEtCO2 should increase to 25.5mmHg in order to improve chest compression quality to deliver better circulation. We can consider termination of resuscitation early for those who had low initial PEtCO2 level.
Subjects
In-hospital Cardiac arrest
Resuscitation
End-tidal Carbon Dioxide
Type
thesis
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