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

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

Research output: Contribution to journalArticle

20 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

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

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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