title: Predicting the lack of ROSC during pre-hospital CPR: should an end-tidal CO2 of 1.3 kPa be used as a cut-off value?
abstract: OBJECTIVE
  The aim of this study was to investigate if an initial ETCO2 value at or below 1.3 kPa can be used as a cut-off value for whether return of spontaneous circulation during pre-hospital cardio-pulmonary resuscitation is achievable or not.
  
  
  METHODS
  We prospectively registered data according to the Utstein-style template for reporting data from pre-hospital advanced airway management from February 1st 2011 to October 31st 2012. Included were consecutive patients at all ages with pre-hospital cardiac arrest treated by eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region.
  
  
  RESULTS
  We registered data from 595 cardiac arrest patients; in 60.2% (n=358) of these cases the pre-hospital critical care teams performed pre-hospital advanced airway management beyond bag-mask ventilation. An initial end-tidal CO2 measurement following pre-hospital advanced airway management were available in 75.7% (n=271) of these 358 cases. We identified 22 patients, who had an initial end-tidal CO2 at or below 1.3 kPa. Four of these patients achieved return of spontaneous circulation.
  
  
  CONCLUSIONS
  Our results indicates that an initial end-tidal CO2 at or below 1.3 kPa during pre-hospital CPR should not be used as a cut-off value for the achievability of return of spontaneous circulation.
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, P.O. Box 94, 1441 Drøbak, Norway; Pre-hospital Critical Care Team, Department of Anaesthesiology, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark; Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Allé 32, 8200 Aarhus N, Denmark; Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark. Electronic address: leifrogn@rm.dk.
authors.forename: Leif
authors.initials: L
authors.lastname: Rognås
authors.affiliation: Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Allé 32, 8200 Aarhus N, Denmark; Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark. Electronic address: troehans@rm.dk.
authors.forename: Troels Martin
authors.initials: TM
authors.lastname: Hansen
authors.affiliation: Centre for Emergency Medicine Research, Aarhus University Hospital, Trøjborgvej 72-74, Building 30, 8200 Aarhus N, Denmark. Electronic address: hanskirk@rm.dk.
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
authors.affiliation: Department of Anaesthesiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark. Electronic address: else.toennesen@aarhus.rm.dk.
authors.forename: Else
authors.initials: E
authors.lastname: Tønnesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation; D002245:Carbon Dioxide; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology* / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013990:Tidal Volume; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: Cardiac arrest; Critical decision making; Emergency medical system; End-tidal CO(2); Helicopter emergency medical system; Pre-hospital critical care