Evaluating the utility of end-tidal CO2 as a predictor of mortality in trauma victims: A systematic review and meta-analysis

Salma Al-Aomar; Jehad Feras AlSamhori; Hamza Alzghoul; Hatem Al-Ghraibeh; Ghayda'a Al-Majali; Samantha Tarras; Heather Dolman; James Tyburski; Gamal Mostafa; Awni D Shahait

doi:10.1016/j.amjsurg.2024.116130

Evaluating the utility of end-tidal CO₂ as a predictor of mortality in trauma victims: A systematic review and meta-analysis

Am J Surg. 2024 Dec 9:240:116130. doi: 10.1016/j.amjsurg.2024.116130. Online ahead of print.

Authors

Affiliations

¹ Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
² Faculty of Medicine, University of Jordan, Amman, Jordan.
³ Internal Medicine, University of Central Florida College of Medicine, Hospital Corporation of America (HCA) Florida North Florida Hospital, Gainesville, USA.
⁴ Division of Acute Care Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
⁵ The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA.
⁶ Beaumont Hospital, Dearborn, MI, USA.
⁷ Department of Surgery, Southern Illinois University School of Medicine, Carbondale, IL, USA. Electronic address: [email protected].

PMID: 39671972
DOI: 10.1016/j.amjsurg.2024.116130

Abstract

Background: Capnography has shown to be an invaluable tool in assessing trauma victims in different setups. To elucidate this, we conducted this meta-analysis to evaluate the utility of end-tidal CO₂ (ETCO₂) and the arterial CO₂ -ETCO₂ gap (PaCO₂-ETCO₂) measurements on predictiveness for mortality in trauma patients.

Methods: A systematic literature search was performed (01/1990-06/2023). The inclusion criteria included adult trauma patients, with mention of mortality. The primary outcome was evaluating the reliability of ETCO₂ in predicting mortality.

Results: Seventeen studies were included, with total of 3445 patients. Mean age was 39.08-year, 22.3 % female. Overall mortality was 25.6 %, mostly retrospective studies. Mean ETCO₂ in survivors was 31.45 mmHg, and 24.75 mmHg in deceased patients, (p = 0.0128). Mean PaCO₂-ETCO₂ gap in survivors was 6.8 mmHg, and 15.0 mmHg in deceased patients, (p < 0.001). Using receiver operator characteristic curve analysis, ETCO₂ of 30.2 mmHg with high sensitivity to predict mortality.

Conclusion: Low ETCO₂ or a wide PaCO₂-ETCO₂ gap were significantly correlated with poor outcomes in trauma patients. This easily obtained value can help predict those who need more aggressive treatments.

Keywords: Capnography; End tidal CO(2); Hemorrhagic shock; Mortality; Trauma; Traumatic brain injury.

Publication types

Review