Predicting the lack of ROSC during pre-hospital CPR: should an end-tidal CO2 of 1.3 kPa be used as a cut-off value?

Leif Rognås; Troels Martin Hansen; Hans Kirkegaard; Else Tønnesen

doi:10.1016/j.resuscitation.2013.12.009

Predicting the lack of ROSC during pre-hospital CPR: should an end-tidal CO2 of 1.3 kPa be used as a cut-off value?

Resuscitation. 2014 Mar;85(3):332-5. doi: 10.1016/j.resuscitation.2013.12.009. Epub 2013 Dec 19.

Authors

Leif Rognås¹, Troels Martin Hansen², Hans Kirkegaard³, Else Tønnesen⁴

Affiliations

¹ Department of Research and Development, Norwegian Air Ambulance Foundation, P.O. Box 94, 1441 Drøbak, Norway; Pre-hospital Critical Care Team, Department of Anaesthesiology, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark; Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Allé 32, 8200 Aarhus N, Denmark; Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark. Electronic address: [email protected].
² Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Allé 32, 8200 Aarhus N, Denmark; Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark. Electronic address: [email protected].
³ Centre for Emergency Medicine Research, Aarhus University Hospital, Trøjborgvej 72-74, Building 30, 8200 Aarhus N, Denmark. Electronic address: [email protected].
⁴ Department of Anaesthesiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark. Electronic address: [email protected].

PMID: 24361671
DOI: 10.1016/j.resuscitation.2013.12.009

Abstract

Aim: The aim of this study was to investigate if an initial ETCO2 value at or below 1.3 kPa can be used as a cut-off value for whether return of spontaneous circulation during pre-hospital cardio-pulmonary resuscitation is achievable or not.

Materials and methods: We prospectively registered data according to the Utstein-style template for reporting data from pre-hospital advanced airway management from February 1st 2011 to October 31st 2012. Included were consecutive patients at all ages with pre-hospital cardiac arrest treated by eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region.

Results: We registered data from 595 cardiac arrest patients; in 60.2% (n=358) of these cases the pre-hospital critical care teams performed pre-hospital advanced airway management beyond bag-mask ventilation. An initial end-tidal CO2 measurement following pre-hospital advanced airway management were available in 75.7% (n=271) of these 358 cases. We identified 22 patients, who had an initial end-tidal CO2 at or below 1.3 kPa. Four of these patients achieved return of spontaneous circulation.

Conclusion: Our results indicates that an initial end-tidal CO2 at or below 1.3 kPa during pre-hospital CPR should not be used as a cut-off value for the achievability of return of spontaneous circulation.

Keywords: Cardiac arrest; Critical decision making; Emergency medical system; End-tidal CO(2); Helicopter emergency medical system; Pre-hospital critical care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Blood Circulation
Carbon Dioxide
Cardiopulmonary Resuscitation*
Child
Child, Preschool
Emergency Medical Services*
Female
Humans
Infant
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / physiopathology*
Out-of-Hospital Cardiac Arrest / therapy*
Predictive Value of Tests
Prospective Studies
Tidal Volume
Treatment Failure
Young Adult

Substances

Carbon Dioxide