Abstract
Purpose
We investigated the predictive value of the gradient between arterial carbon dioxide
(PaCO2) and end-tidal carbon dioxide (ETCO2) (Pa-ETCO2) in post-cardiac arrest patients for in-hospital mortality.
Methods
This retrospective observational study evaluated cardiac arrest patients admitted
to the emergency department of a tertiary university hospital. The PaCO2 and ETCO2 values at 6, 12, and 24 h after return of spontaneous circulation (ROSC) were obtained
from medical records and Pa-ETCO2 gap was calculated as the difference between PaCO2 and ETCO2 at each time point. Multivariate logistic regression analysis was performed to verify
the relationship between Pa-ETCO2 gap and clinical variables. Receiver operating characteristic (ROC) curve analysis
was performed to determine the cutoff value of Pa-ETCO2 for predicting in-hospital mortality.
Results
The final analysis included 58 patients. In univariate analysis, Pa-ETCO2 gaps were significantly lower in survivors than in non-survivors at 12 h [12.2 (6.5–14.8)
vs. 13.9 (12.1–19.6) mmHg, p = 0.040] and 24 h [9.1 (6.3–10.5) vs. 17.1 (13.1–23.2) mmHg, p < 0.001)] after ROSC. In multivariate analysis, Pa-ETCO2 gap at 24 h after ROSC was related to in-hospital mortality [odds ratio (95% confidence
interval): 1.30 (1.07–1.59), p = 0.0101]. In ROC curve analysis, the optimal cut-off value of Pa-ETCO2 gap at 24 h after ROSC was 10.6 mmHg (area under the curve, 0.843), with 77.8% sensitivity
and 85.7% specificity.
Conclusion
The Pa-ETCO2 gap at 24 h after ROSC was associated with in-hospital mortality in post-cardiac
arrest patients.
Keywords
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References
- Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation. 2015; 132: S444-64
- Part 3. Advanced cardiac life support: 2015 Korean guidelines for cardiopulmonary resuscitation.Clin Exp Emerg Med. 2016; 3: S17-26
- European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support.Resuscitation. 2015; 95: 100-147
- End-tidal carbon dioxide concentration during cardiopulmonary resuscitation.N Engl J Med. 1988; 318: 607-611
- Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting?.Resuscitation. 2003; 58: 89-96
- Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?.Eur J Emerg Med. 2001; 8: 263-269
- End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation: a prognostic indicator for survival.JAMA. 1989; 262: 1347-1351
- Utstein style analysis of out-of-hospital cardiac arrest—bystander CPR and end expired carbon dioxide.Resuscitation. 2007; 72: 404-414
- Capnography for adults.Crit Care Clin. 1995; 11: 219-232
- Respiratory dead space and arterial to end-tidal CO2 tension difference in anesthetized man.J Appl Physiol. 1960; 15: 383-389
- Deadspace and the single breath test for carbon dioxide during anaesthesia and artificial ventilation. Effects of tidal volume and frequency of respiration.Br J Anaesth. 1984; 56: 109-119
- The arterial to end-expiratory carbon dioxide tension gradient in acute pulmonary embolism and other cardiopulmonary diseases.Chest. 1974; 66: 352-357
- Estimating alveolar dead space from the arterial to end-tidal CO(2) gradient: a modeling analysis.Anesth Analg. 2003; 97: 1846-1851
- Invasive and noninvasive measurement of the respiratory deadspace in anesthetized children with cardiac disease.Anesth Analg. 1988; 67442–7
- Establishing a gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in patients with acute respiratory distress syndrome.J Invest Med. 2017; 65: 338-341
- Relationship between cardiac output and the end-trial carbon dioxide tension.Ann Emerg Med. 1990; 19: 1104-1106
- Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure.Chest. 1987; 92: 832-835
- The CO2 GAP project–CO2 GAP as a prognostic tool in emergency departments.Emerg Med Australas. 2010; 22: 524-531
- End-tidal CO2-arterial CO2 differences: a useful intraoperative mortality marker in trauma surgery.J Trauma. 2003; 55: 892-897
- Parenchymal lung injuries related to standard cardiopulmonary resuscitation.Am J Emerg Med. 2017; 35: 117-121
- Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome.Circulation. 2002; 106: 562-568
- The role of the immuno-inflammatory response in patients after cardiac arrest.Arch Med Sci. 2011; 7: 619-626
- The risk factors and prognostic implication of acute pulmonary edema in resuscitated cardiac arrest patients.Clin Exp Emerg Med. 2015; 2: 110-116
- Early-onset pneumonia after out-of-hospital cardiac arrest.J Infect. 2015; 70: 553-562
- Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning.J Am Coll Cardiol. 1996; 28: 232-240
- Post–cardiac arrest syndrome.Circulation. 2008; 118: 2452-2483
- Cost effectiveness of aggressive care for patients with nontraumatic coma.Crit Care Med. 2002; 30: 1191-1196
- Is this patient dead, vegetative, or severely neurologically impaired?: assessing outcome for comatose survivors of cardiac arrest.JAMA. 2004; 291: 870-879
- Validation of a new coma scale: the FOUR score.Ann Neurol. 2005; 58: 585-593
- Predicting outcome from hypoxic-ischemic coma.JAMA. 1985; 253: 1420-1426
- Serum neuron–specific enolase as a prognostic marker for irreversible brain damage in comatose cardiac arrest survivors.Acad Emerg Med. 1996; 3: 126-131
- S-100 protein as early predictor of regaining consciousness after out of hospital cardiac arrest.Resuscitation. 2002; 53: 251-257
- Systematic review of early prediction of poor outcome in anoxicischaemic coma.Lancet. 1998; 352: 1808-1812
- Part 8: Post–cardiac arrest care.Circulation. 2015; 132: S465-82
Article Info
Publication History
Published online: April 14, 2018
Accepted:
April 13,
2018
Received in revised form:
March 10,
2018
Received:
January 19,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
