Arterial minus end-tidal CO2 as a prognostic factor of hospital survival in patients resuscitated from cardiac arrest

Sungwoo Moon, Sung Woo Lee, Sung Hyuk Choi, Yun Sik Hong, Su Jin Kim, Nak Hoon Kim

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Aims: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO2 [P(a-et)CO2] and alveolar dead space ventilation ratio (VdA/Vt) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department. Materials and methods: Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO2 (EtCO2), P(a-et)CO2, and VdA/Vt were evaluated at 1 h after ROSC. We compared these variables between hospital survivors and non-survivors. Results: The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7%, respectively, p = 0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a-et)CO2, and lower VdA/Vt value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a-et)CO2, and VdA/Vt showed significant sensitivity and specificity for hospital mortality. Specifically, lactate ≥10.0 mmol/L, P(a-et)CO2 ≥ 12.5 mmHg, and VdA/Vt ≥ 0.348 were all associated with high hospital mortality (p = 0.000, 0.001 and 0.000, respectively). Conclusions: This study showed that high serum lactate, high P(a-et)CO2 and high VdA/Vt during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a-et)CO2 and VdA/Vt may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments.

Original languageEnglish
Pages (from-to)219-225
Number of pages7
JournalResuscitation
Volume72
Issue number2
DOIs
Publication statusPublished - 2007 Feb 1

Fingerprint

Heart Arrest
Lactic Acid
Hospital Mortality
Survival
Survivors
Hospital Emergency Service
Serum
Arterial Pressure
Ventricular Fibrillation
Ventricular Tachycardia
Resuscitation
Teaching Hospitals
Ventilation
Gases
Guidelines
Sensitivity and Specificity

Keywords

  • Arterial carbon dioxide
  • Arterial to end-tidal CO difference
  • Cardiac arrest
  • Dead space ventilation ratio
  • End-tidal carbon dioxide
  • Lactate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Arterial minus end-tidal CO2 as a prognostic factor of hospital survival in patients resuscitated from cardiac arrest. / Moon, Sungwoo; Lee, Sung Woo; Choi, Sung Hyuk; Hong, Yun Sik; Kim, Su Jin; Kim, Nak Hoon.

In: Resuscitation, Vol. 72, No. 2, 01.02.2007, p. 219-225.

Research output: Contribution to journalArticle

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abstract = "Aims: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO2 [P(a-et)CO2] and alveolar dead space ventilation ratio (VdA/Vt) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department. Materials and methods: Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO2 (EtCO2), P(a-et)CO2, and VdA/Vt were evaluated at 1 h after ROSC. We compared these variables between hospital survivors and non-survivors. Results: The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7{\%}, respectively, p = 0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a-et)CO2, and lower VdA/Vt value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a-et)CO2, and VdA/Vt showed significant sensitivity and specificity for hospital mortality. Specifically, lactate ≥10.0 mmol/L, P(a-et)CO2 ≥ 12.5 mmHg, and VdA/Vt ≥ 0.348 were all associated with high hospital mortality (p = 0.000, 0.001 and 0.000, respectively). Conclusions: This study showed that high serum lactate, high P(a-et)CO2 and high VdA/Vt during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a-et)CO2 and VdA/Vt may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments.",
keywords = "Arterial carbon dioxide, Arterial to end-tidal CO difference, Cardiac arrest, Dead space ventilation ratio, End-tidal carbon dioxide, Lactate",
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T1 - Arterial minus end-tidal CO2 as a prognostic factor of hospital survival in patients resuscitated from cardiac arrest

AU - Moon, Sungwoo

AU - Lee, Sung Woo

AU - Choi, Sung Hyuk

AU - Hong, Yun Sik

AU - Kim, Su Jin

AU - Kim, Nak Hoon

PY - 2007/2/1

Y1 - 2007/2/1

N2 - Aims: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO2 [P(a-et)CO2] and alveolar dead space ventilation ratio (VdA/Vt) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department. Materials and methods: Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO2 (EtCO2), P(a-et)CO2, and VdA/Vt were evaluated at 1 h after ROSC. We compared these variables between hospital survivors and non-survivors. Results: The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7%, respectively, p = 0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a-et)CO2, and lower VdA/Vt value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a-et)CO2, and VdA/Vt showed significant sensitivity and specificity for hospital mortality. Specifically, lactate ≥10.0 mmol/L, P(a-et)CO2 ≥ 12.5 mmHg, and VdA/Vt ≥ 0.348 were all associated with high hospital mortality (p = 0.000, 0.001 and 0.000, respectively). Conclusions: This study showed that high serum lactate, high P(a-et)CO2 and high VdA/Vt during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a-et)CO2 and VdA/Vt may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments.

AB - Aims: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO2 [P(a-et)CO2] and alveolar dead space ventilation ratio (VdA/Vt) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department. Materials and methods: Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO2 (EtCO2), P(a-et)CO2, and VdA/Vt were evaluated at 1 h after ROSC. We compared these variables between hospital survivors and non-survivors. Results: The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7%, respectively, p = 0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a-et)CO2, and lower VdA/Vt value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a-et)CO2, and VdA/Vt showed significant sensitivity and specificity for hospital mortality. Specifically, lactate ≥10.0 mmol/L, P(a-et)CO2 ≥ 12.5 mmHg, and VdA/Vt ≥ 0.348 were all associated with high hospital mortality (p = 0.000, 0.001 and 0.000, respectively). Conclusions: This study showed that high serum lactate, high P(a-et)CO2 and high VdA/Vt during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a-et)CO2 and VdA/Vt may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments.

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KW - Arterial to end-tidal CO difference

KW - Cardiac arrest

KW - Dead space ventilation ratio

KW - End-tidal carbon dioxide

KW - Lactate

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