Increase in end-tidal carbon dioxide after defibrillation predicts sustained return of spontaneous circulation during out-of-hospital cardiac arrest.

Autor: Grabman B; University of New Mexico School of Medicine, United States. Electronic address: BGrabman@salud.unm.edu., Bulger NE; University of Washington School of Medicine, United States., Harrington BM; Zucker School of Medicine at Hofstra/Northwell, United States., Walker RG; Stryker Emergency Care, United States., Latimer AJ; University of Washington School of Medicine, United States., Snyder BD; University of Washington School of Medicine, United States., Sayre MR; University of Washington School of Medicine, United States; Seattle Fire Department, United States., Maynard C; University of Washington School of Public Health, United States., Johnson NJ; University of Washington School of Medicine, United States., Van Dyke M; University of Washington School of Medicine, United States., Counts CR; University of Washington School of Medicine, United States; Seattle Fire Department, United States.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2022 Dec; Vol. 181, pp. 48-54. Date of Electronic Publication: 2022 Oct 14.
DOI: 10.1016/j.resuscitation.2022.10.001
Abstrakt: Introduction: Guidelines recommend monitoring end-tidal carbon dioxide (E T CO 2 ) during out-of-hospital cardiac arrest (OHCA), though its prognostic value is poorly understood. This study investigated the relationship between E T CO 2 and return of spontaneous circulation (ROSC) after defibrillation in intubated non-traumatic OHCA patients.
Methods: This retrospective, observational cohort analysis included adult OHCA patients who received a defibrillation shock during treatment by an urban EMS agency from 2015 to 2021. Peak E T CO 2 values were determined for the 90-second periods before and after the first defibrillation in an intubated patient (shock of interest [SOI]). Values were analyzed for association between the change in E T CO 2 from pre- to post-shock and the presence of ROSC on the subsequent pulse check.
Results: Of 518 eligible patients, mean age was 61, 72% were male, 50% had a bystander-witnessed arrest, and 62% had at least one episode of ROSC. The most common arrest etiology was medical (92%). Among all patients, peak E T CO 2 during resuscitation prior to SOI was 36.8 mmHg (18.6). E T CO 2 increased in patients who achieved ROSC immediately after SOI (from 38.3 to 47.6 mmHg; +9.3 CI: 6.5, 12.1); patients with sustained ROSC experienced the greatest increase in E T CO 2 after SOI (from 37.8 to 48.2 mmHg; +10.4 CI: 7.2, 13.6), while E T CO 2 in patients who did not achieve ROSC after SOI rose (from 36.4 to 37.8 mmHg; +1.4 CI: -0.1, 2.8).
Conclusions: E T CO 2 rises after defibrillation in most patients during cardiac arrest. Patients with sustained ROSC experience larger rises, though the majority experience rises of less than 10 mmHg.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
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