Abstract
Background
Field sepsis alerts have the ability to expedite initial ED sepsis treatment. Our
hypothesis is that in patients that meet EMS sepsis alert criteria there is a strong
relationship between prehospital end-tidal carbon dioxide (ETCO2) readings and the
outcome of diagnosed infection.
Methods
In 2014, our EMS service initiated a protocol requiring hospitals to receive notification
of a “sepsis alert” on all suspected sepsis patients. The EMS service transports 70,000
patients/year to a number of urban centers. All patients transported to our major
urban teaching hospital by our EMS service in one year in which a sepsis alert was
announced were included in this study. The primary outcome variable was diagnosed
infection and secondary outcomes were hospital admission, ICU admission and mortality.
Positive lactate was defined as >4.0 mmol/L. ROC curve analysis was used to define
the best cutoff for ETCO2.
Results
351 patients were announced as EMS sepsis alert patients and transported to our center
over a one year period. Positive outcomes were as follows: diagnosed infection in
28% of patients, hospital admission in 63% and ICU admission in 11%. The correlation
between lactate and ETCO2 was −0.45. A ROC curve analysis of ETCO2 vs. lactate >4
found that the best cutoff to predict a high lactate was an ETCO2 of 25 or less, which
was considered a positive ETCO2 (AUC = 0.73). 27% of patients had a positive ETCO2
and 24% had a positive lactate. A positive ETCO2 predicted a positive lactate with
76% accuracy, 63% sensitivity and 80% specificity. 27% of those with a positive ETCO2
and 44% of those with a positive lactate had a diagnosed infection. 59% of those with
a positive ETCO2 and 89% of those with a positive lactate had admission to the hospital.
15% of those with a positive ETCO2 and 18% of those with a positive lactate had admission
to the ICU. Neither lactate nor ETCO2 were predictive of an increased risk for diagnosed
infection, hospital admission or ICU admission in this patient population.
Conclusion
While ETCO2 predicted the initial ED lactate levels it did not predict diagnosed infection,
admission to the hospital or ICU admission in our patient population but did predict
mortality.
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Article Info
Publication History
Published online: November 08, 2018
Accepted:
November 6,
2018
Received in revised form:
October 22,
2018
Received:
September 14,
2018
Footnotes
☆Presented at SAEM May 2017, Orlando, FL.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
