Yasemin KARCIOĞLU, Özgür KARCIOĞLU

Role of end-tidal $CO_2$ monitoring in patients intubated and resuscitated in the emergency department

We examined the reliability of end-tidal $CO_2$ ($ETCO_2$ ) level in predicting mortality after endotracheal intubation in emergency situations. Methods: In this prospective study, the reliability of $ETCO_2$ monitoring in the emergency setting as a useful predictor of outcome was investigated in 36 adult patients with pending cardiopulmonary collapse. The cardiopulmonary resuscitation (CPR) procedure was performed as usual and the cardiac rhythm, arterial $O_2$ saturation, non- invasive blood pressure and $ETCO_2$ levels were continuously monitored in all the patients. Results: Patients with an $ETCO_2$ concentration below 0.5% had significantly lower rates of survival. The sensitivity and specificity values of end-tidal $CO_2$ levels equal to or greater than 0.5% in predicting survival were 100% and 42.8%, respectively. None of the 8 patients with levels below 0.5% survived. An end-tidal $CO_2$ concentration level of 0.5% served to discriminate between survivors and non-survivors. Conclusions: These results suggest that the initial $ETCO_2$ concentration can be an important predictor of outcome, especially with regard to mortality in patients undergoing endotracheal intubation.

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1. Domsky M, Wilson RF, Heins J. Intraoperative end-tidal carbon dioxide values and derived calculations correlated with outcome: prognosis and capnography. Crit Care Med 23:1497- 1503, 1995.
2. Sum Ping ST, Mehta MP, Symreng T. Accuracy of the FEF CO2 detector in the assessment of endotracheal tube placement. Anesth Analg 74:415-19, 1992.
3. Wilson RF, Tyburski JG, Kubinec SM. Intraoperative end-tidal carbon dioxide levels and derived calculations correlated with outcome in trauma patients. J Trauma 41: 606-11, 1996.
4. Sanders AB, Atlas M. Expired CO2 as an index of coronary perfusion pressure. Am J Emerg Med 3:147-49, 1985.
5. Sanders AB, Ewy GA, Bragg S, Taft TV. Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest. Ann Emerg Med 14:948-52, 1985.
6. Weil MH, Bisera J, Trevino RR, Rackow EC. Cardiac output and end-tidal carbon dioxide. Crit Care Med 13;907-09, 1985.
7. Sanders AB, Kern KB, Otto CW, Ewy GA. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. A prognostic indicator for survival. JAMA 262:1347-51, 1989.
8. Ornato JP, Shipley JB, Racht EM, Slovis CM. Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med 21:518-23, 1992.
9. Emergency Cardiac Care Committee and Subcommittees. American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 286:2171-2302, 1992.
10. Cantineau JP, Lambert Y, Merckx P, Reynaud P, Porte F, Bertrand C, Duvaldestin P. End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome. Crit Care Med 24:791-96, 1996.
11. Callaham M, Barton C. Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med 18:358-62, 1990.
12. Ornato JP, Gonzalez ER, Garnett R, Levine RL, Racht EM, Young DS. Effect of cardiopulmonary resuscitation compression rate on end-tidal carbon dioxide concentration and arterial pressure in man. Crit Care Med 16:241- 44, 1988.
13. Levine RL, Wayne MA, Miller CC. Endtidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med 337: 301-06, 1997.
14. Steedman DJ, Robertson CE. Measurement of end-tidal carbon dioxide concentration during cardiopulmonary resuscitation. Arch Emerg Med 7:129-34, 1990.