Association between delta ETCO2 and Return of Spontaneous Circulation in a National US Cohort
Abstract Body: Introduction: International guidelines support use of end-tidal carbon dioxide (ETCO2) for monitoring resuscitation in out-of-hospital cardiac arrest (OHCA). Specific ETCO2 cutoffs have been proposed for termination of resuscitation, though data on rates of ROSC based on changes in ETCO2 is limited. We aimed to evaluate the relationship between change in ETCO2 in OHCA and its relationship to return of spontaneous circulation (ROSC) using a US national database.
Methods: This retrospective analysis of National Emergency Medical Services Information System (NEMSIS) datasets from 2020 to 2022 evaluated all adult patients who underwent resuscitation for OHCA and had multiple ETCO2 measurements. We excluded cases with missing data. The highest difference between two sequential ETCO2 measurements (MΔETCO2) and total difference between minimum and maximum ETCO2 measurements [TΔETCO2] were calculated for each case. ΔETCO2 groups were stratified into 10-unit increments and we compared rates of ROSC between groups. We then used multivariable logistic regression to evaluate the association between each 5 unit increase in ΔETCO2 and ROSC. We adjusted for age, sex, location, witness status, initial shockable rhythm, and CPR or AED prior to EMS arrival.
Results: We included 274,516 total patients with 1,686,390 ETCO2 measurements. The median number of ETCO2 measurements was 5 (IQR 3-8). Median age was 65, 62.8% were male, 60.1% had witnessed arrests, and 78.3% received CPR and 32.3% received AED placement prior to EMS arrival. ROSC rates based on MΔETCO2 were 0-10 mmHg [33.3%], 10-20 mmHg [42.3%], 20-30 mmHg [49.7%], 30-40 mmHg [53.2%], and >40 mmHg [56.6%]. ROSC rates for TΔETCO2 were 0-10 mmHg [29.6%], 10-20 mmHg [36.7%], 20-30 mmHg [43.5%], 30-40 mmHg [48.9%], and >40 mmHg [54.6%]. Adjusted odds of ROSC per 10 mmHg increase in MΔETCO2 was 1.21 [1.21-1.22] and TΔETCO2 was 1.19 [1.19-1.19].
Conclusions: Increasing max and overall ΔETCO2 was associated with increased rates and odds of ROSC for OHCA.
Grabman, Bartholomew
( University of New Mexico
, Albuquerque
, New Mexico
, United States
)
Fisher, Benjamin
( NEMSIS TAC
, Salt Lake City
, Utah
, United States
)
Mann, N. Clay
( University of Utah Medicine
, Salt Lake City
, Utah
, United States
)
Braude, Darren
( UNM
, Albuquerque
, New Mexico
, United States
)
Huebinger, Ryan
( University of New Mexico
, Albuquerque
, New Mexico
, United States
)
Author Disclosures:
Bartholomew Grabman:DO NOT have relevant financial relationships
| Benjamin Fisher:DO NOT have relevant financial relationships
| N. Clay Mann:No Answer
| Darren Braude:DO NOT have relevant financial relationships
| Ryan Huebinger:DO NOT have relevant financial relationships
