Prehospital end-tidal carbon dioxide concentration and outcome in major trauma.
BACKGROUND
End-tidal carbon dioxide (Petco2) concentration is a marker of the pathophysiologic state because it is a reflection of cardiac output. Petco2 correlates with outcome after prehospital primary cardiac arrest, but association with outcome from prehospital trauma has not been established.


METHODS
Between 1998 and 2001, Petco2 was recorded in 191 blunt trauma patients requiring prehospital intubation. Rapid sequence intubation was performed using suxamethonium (1 mg/kg) and etomidate (0.2-0.3 mg/kg). Initial Petco2 after endotracheal intubation (t0) and Petco2 at 20 minutes after endotracheal intubation (t20) were recorded, together with survival to discharge.


RESULTS
Median Petco2 at t20 was 4.10 kPa in survivors and 3.50 kPa in nonsurvivors (95% confidence interval of difference between medians, 0.40 to 0.90 kPa; p < 0.0001). Petco2 at t20 was a better predictor of outcome than at t0.


CONCLUSIONS
Only 5% patients with Petco2 < 3.25 kPa survived to discharge. Petco2 at t20 is of value in predicting outcome from major trauma.
Helicopter Emergency Service, Royal London Hospital, Whitechapel, London, United Kingdom. charlesdeakin@doctors.org.uk
Charles D
CD
Deakin
Daniel M
DM
Sado
Timothy J
TJ
Coats
Gareth
G
Davies
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D019296:Capnography / Q000379:methods*; D002245:Carbon Dioxide / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013990:Tidal Volume; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy
D002245:Carbon Dioxide