Initial end-tidal CO2 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

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2367-2371
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

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Partial Pressure
Heart Arrest
Resuscitation
Odds Ratio
Capnography
Confidence Intervals
Out-of-Hospital Cardiac Arrest
Survival
Ventricular Fibrillation
Ventricular Tachycardia
Carbon Dioxide
Nervous System
Hospital Emergency Service
Retrospective Studies
Demography
Guidelines
Lung
Research
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

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Initial end-tidal CO2 partial pressure predicts outcomes of in-hospital cardiac arrest. / Wang, An Yi; Huang, Chien Hua; Chang, Wei Tien; Tsai, Min Shan; Wang, Chih Hung; Chen, Wen Jone.

In: American Journal of Emergency Medicine, Vol. 34, No. 12, 01.12.2016, p. 2367-2371.

Research output: Contribution to journalArticle

Wang, An Yi ; Huang, Chien Hua ; Chang, Wei Tien ; Tsai, Min Shan ; Wang, Chih Hung ; Chen, Wen Jone. / Initial end-tidal CO2 partial pressure predicts outcomes of in-hospital cardiac arrest. In: American Journal of Emergency Medicine. 2016 ; Vol. 34, No. 12. pp. 2367-2371.
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abstract = "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.",
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