Jp. Cantineau et al., END-TIDAL CARBON-DIOXIDE DURING CARDIOPULMONARY-RESUSCITATION IN HUMANS PRESENTING MOSTLY WITH ASYSTOLE - A PREDICTOR OF OUTCOME, Critical care medicine, 24(5), 1996, pp. 791-796
Objective: To determine whether continuous semiquantitative assessment
of end-tidal CO2 could provide a highly sensitive predictor of return
of spontaneous circulation during cardiopulmonary resuscitation (CPR)
. Design: Prospective, clinical study, Setting: Prehospital CPR, Patie
nts: One hundred twenty patients, during nontraumatic cardiac arrest.
Interventions: End-tidal CO2 values were measured continuously after t
racheal intubation, and were categorized as the initial value, and as
minimal and maximal values during the first 20 mins. Measurements and
Main Results: Presenting rhythm was asystole in 22 of the first 24 pat
ients, Return of spontaneous circulation occurred in eight patients, I
nitial, minimal, and maximal end tidal CO2 values were significantly (
p < .01) higher in these patients than in the patients without return
of spontaneous circulation. Cutoff values providing a 100% sensitivity
and the highest specificity in predicting return of spontaneous circu
lation were found to be 10 torr for initial and maximal end tidal CO2
values, and 2 torr for the minimal end-tidal CO2 value, The number of
patients required to reject (with a risk error of < .05) the hypothesi
s of an actual sensitivity of less than or equal to 90% for an observe
d sensitivity of 100% was found to be 95, In the second part of the st
udy, this hypothesis was prospectively tested for initial and maximal
end-tidal CO2 values in the subsequent 96 patients. Presenting cardiac
rhythm was asystole in 87 patients. Return of spontaneous circulation
was obtained in 30 patients. The cutoff value of 10 torr for maximal
end tidal CO2 during the first 20 mins after tracheal intubation provi
ded an observed sensitivity of 100% in predicting return of spontaneou
s circulation with a specificity of 67%. This result allows rejection
of the hypothesis of an actual sensitivity of less than or equal to 90
% (p = .042). By contrast, the observed sensitivity of initial end-tid
al CO2 was only 87%. Conclusions: End-tidal CO2 represents a valuable
tool for monitoring patients presenting with asystole during prehospit
al CPR, Fluctuations in end tidal CO2 during CPR and the utility of en
d-tidal CO2 in detecting return of spontaneous circulation justify its
continuous measurement. In addition, a high sensitivity (>90%) in pre
dicting return of spontaneous circulation is prospectively demonstrate
d using the maximal end-tidal CO2 during the first 20 mins after trach
eal intubation, with a cutoff value of 10 torr, Such a prognostic indi
cator could be used for a more rational approach to prolonged CPR.