Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest

Hubble, Michael W.; Vleet, Lee Van; Taylor, Stephen; Bachman, Michael W; Williams, Jeffrey M.; Vipperman, Raymond; Renkiewicz, Ginny K

doi:10.1080/10903127.2020.1828518

Cited by 6 publications

(9 citation statements)

References 29 publications

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“…This was consistent when analyses included all available ETCO 2 readings, as well as when only the first available measurement was used. This is in contrast to previous studies using only advanced airways which have shown that predefibrillation ETCO 2 for all shocks can predict defibrillation success resulting in VF termination or ROSC 11–14. Our ability to measure predefibrillation ETCO 2 readings through BVM and SGAs, in addition to ETT, is an important distinguishing factor and strength of our study that may explain the difference in results.…”

Section: Discussioncontrasting

confidence: 66%

“…Current evidence suggests that these are the highest yield interventions for patients in OHCA 10. If predefibrillation ETCO 2 is proposed as a marker for the optimal timing of VF defibrillation,11–14 a measure of CPR quality and patient prognostication, a more easily accessible and reliable measure is likely required. Only then will we be able to gradually move away from the current algorithmic approach to ACLS management.…”

Section: Discussionmentioning

confidence: 99%

“…One study found that in patients with ETCO 2 of <7 mm Hg (0.93 kPa), no shocks were successful at terminating VF, and in patients with ETCO 2 of >45 mm Hg (6.00 kPa), all shocks were successful 11. All four studies concluded that higher predefibrillation ETCO 2 was associated with a significantly higher likelihood of achieving ROSC, with two of the studies showing a higher likelihood of achieving ROSC only after the first defibrillation 11–14…”

Section: Introductionmentioning

confidence: 99%

“…Predefibrillation end-tidal CO 2 (ETCO 2 ) has emerged as a potential tool to guide the optimal timing of defibrillation 11–14. Several groups have studied the association between the ETCO 2 value prior to defibrillation and the likelihood of termination of VF/pulseless ventricular tachycardia (pVT) and return of spontaneous circulation (ROSC) after defibrillation.…”

Section: Introductionmentioning

confidence: 99%

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Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

et al. 2022

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BackgroundPredefibrillation end-tidal CO2 (ETCO2) may predict defibrillation success and could guide defibrillation timing in ventricular fibrillation (VF) cardiac arrest. This relationship has only been studied using advanced airways. Our aim was to evaluate this relationship using both basic (bag–valve–mask (BVM)) and advanced airways (supraglottic airways and endotracheal tubes).MethodsPrehospital patient records and defibrillator files were abstracted for patients with out-of-hospital cardiac arrest in Ontario, Canada, with initial VF cardiac rhythms between 1 January 2018, and 31 December 2019. Analyses assessed the relationship between each predefibrillation ETCO2 reading and defibrillation outcomes at the subsequent 2 min pulse check (ie, VF, asystole, pulseless electrical activity (PEA) or return of spontaneous circulation (ROSC)), accounting for airway types used during resuscitation. Multivariable logistic regression evaluated the association between the first documented predefibrillation ETCO2 and postshock VF termination or ROSC.ResultsOf 269 cases abstracted, 153 had predefibrillation ETCO2 measurements and were included in the study. Among these cases, 904 shocks were delivered and 44.4% (n=401) had predefibrillation ETCO2 measured. The first ETCO2 reading was more often from BVM (n=134) than advanced airways (n=19). ETCO2 readings were lower when measured through BVM versus advanced airways (30.5 mm Hg (4.06 kPa) (±14.4 mm Hg (1.92 kPa)) vs 42.1 mm Hg (5.61 kPa) (±22.5 mm Hg (3.00 kPa)), adjANOVA p<0.01). Of all shocks with ETCO2 reading (n=401), no difference in preshock ETCO2 was found for subsequent shocks that resulted in persistent VF (32.2 mm Hg (4.29 kPa) (±15.8 mm Hg (2.11 kPa))), PEA (32.8 mm Hg (4.37 kPa) (±17.1 mm Hg (2.30 kPa))), asystole (32.4 mm Hg (4.32 kPa) (±20.6 mm Hg (2.75 kPa))) or ROSC (32.5 mm Hg (4.33 kPa) (±15.3 mm Hg (2.04 kPa))), analysis of variance p=0.99. In the multivariate analysis using the initial predefibrillation ETCO2, there was no association with VF termination on the subsequent shock (adjusted OR (adjOR) 0.99, 95% CI 0.97 to 1.02, p=0.57) or ROSC (adjOR 1.00, 95% CI 0.97 to 1.03, p=0.94) when evaluated as a continuous or categorical variable.ConclusionPredefibrillation ETCO2 measurement is not associated with VF termination or ROSC when basic and advanced airways are included in the analysis. The role of predefibrillation ETCO2 requires careful consideration of the type of airway used during resuscitation.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

et al. 2022

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“…Studies on EtCO 2 have focused primarily on patients with CPA and assessed the usefulness of EtCO 2 as a valuable tool that can assess the effectiveness of cardiopulmonary resuscitation (CPR)[6] - [9] and predict the outcome. This is because EtCO 2 correlates well with cardiac output, and no other appropriate noninvasive methods exist to measure this important variable during CPR.…”

Section: Discussionmentioning

confidence: 99%

Association between Intraoperative End-Tidal Carbon Dioxide and Postoperative Organ Dysfunction in Major Abdominal Surgery: A Retrospective Cohort Study

Dong

Takeda

Kamitani

et al. 2022

Preprint

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BackgroundData on the effects of intraoperative end-tidal carbon dioxide (EtCO2) levels on postoperative organ dysfunction are limited. Thus, this study was designed to investigate the relationship between the intraoperative EtCO2 level and postoperative organ dysfunction in patients who underwent major abdominal surgery under general anesthesia.MethodsWe conducted a retrospective cohort study involving patients who underwent major abdominal surgery under general anesthesia at Kyoto University Hospital. We classified those with a mean EtCO2 of less than 35 mmHg as low EtCO2. The time effect was determined as the minutes when the EtCO2 value was below 35 mmHg, whereas the cumulative effect was evaluated by measuring the area below the 35-mmHg threshold. The outcome was postoperative organ dysfunction, defined as a composite of at least one organ dysfunction among acute renal injury, circulatory dysfunction, respiratory dysfunction, coagulation dysfunction, and liver dysfunction within 7 days after surgery.ResultsOf the 4,171 patients, 1,195 (28%) had low EtCO2, and 1,428 (34%) had postoperative organ dysfunction. An association was found between low EtCO2 and increased postoperative organ dysfunction (adjusted risk ratio, 1.11; 95% confidence interval [CI], 1.03–1.20; p = 0.006). Additionally, long-term exposure to EtCO2 values of less than 35 mmHg (≥224 min) was associated with postoperative organ dysfunction (adjusted risk ratio, 1.18; 95% CI, 1.06–1.32; p = 0.003) and low EtCO2 severity (area under the threshold) (adjusted risk ratio, 1.13; 95% CI, 1.02–1.26; p = 0.018).ConclusionsIntraoperative low EtCO2 of below 35 mmHg was associated with increased postoperative organ dysfunction.

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End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients

Baldi

Caputo²,

Klersy³

et al. 2022

Resuscitation

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Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest

Cited by 6 publications

References 29 publications

Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

Association between Intraoperative End-Tidal Carbon Dioxide and Postoperative Organ Dysfunction in Major Abdominal Surgery: A Retrospective Cohort Study

End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients

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Predictive Utility of End-Tidal Carbon Dioxide on Defibrillation Success in Out-of-Hospital Cardiac Arrest

Cited by 6 publications

References 29 publications

Predefibrillation end-tidal CO2and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

Predefibrillation end-tidal CO2and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

Association between Intraoperative End-Tidal Carbon Dioxide and Postoperative Organ Dysfunction in Major Abdominal Surgery: A Retrospective Cohort Study

End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients

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Product

Resources

About

Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

Predefibrillation end-tidal CO₂and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study