Initial end-tidal carbon dioxide as a prognostic indicator for inpatient PEA arrest.
OBJECTIVE
Investigate the relationship of initial PetCO2 values of patients during inpatient pulseless electrical activity (PEA) cardiopulmonary arrest with return of spontaneous circulation (ROSC) and survival to discharge.


METHODS
This study was performed in two urban, academic inpatient hospitals. Patients were enrolled from July 2009 to July 2013. A comprehensive database of all inpatient resuscitative events is maintained at these institutions, including demographic, clinical, and outcomes data. Arrests are stratified by primary etiology of arrest using a priori criteria. Inpatients with PEA arrest for whom recorded PetCO2 was available were included in the analysis. Capnography data obtained after ROSC and/or more than 10 min after initiation of CPR were excluded. Multivariable logistic regression was used to explore the association between initial PetCO2 >20 mmHg and both ROSC and survival-to-discharge.


RESULTS
A total of 50 patients with PEA arrest and pre-ROSC capnography were analyzed. CPR continued an average of 11.8 min after initial PetCO2 was recorded confirming absence of ROSC at time of measurement. Initial PetCO2 was higher in patients with versus without eventual ROSC (25.3 ± 14.4 mmHg versus 13.4 ± 6.9 mmHg, P = 0.003). After adjusting for age, gender, and arrest location (ICU versus non-ICU), initial PetCO2 >20 mmHg was associated with increased likelihood of ROSC (adjusted OR 4.8, 95% CI 1.2-19.2, P = 0.028). Initial PetCO2 was not significantly associated with survival-to-discharge (P = 0.251).


CONCLUSIONS
Initial PetCO2 >20 mmHg during CPR was associated with ROSC but not survival-to-discharge among inpatient PEA arrest victims. This analysis is limited by relatively small sample size.
Tulane University School of Medicine, New Orleans, LA, United States.
Alex K
AK
Pearce
Department of Emergency Medicine, UC San Diego, San Diego, CA, United States.
Daniel P
DP
Davis
Division of Anesthesiology & Critical Care, Department of Anesthesia, UC San Diego, San Diego, CA, United States.
Anushirvan
A
Minokadeh
Division of Pulmonary & Critical Care, Department of Medicine, UC San Diego, 9300 Campus Point Drive #7381, La Jolla, CA, United States. Electronic address: rsell@ucsd.edu.
Rebecca E
RE
Sell
D000368:Aged; D002140:California / Q000453:epidemiology; D019296:Capnography / Q000379:methods*; D002245:Carbon Dioxide / Q000032:analysis*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013990:Tidal Volume / Q000502:physiology*
D002245:Carbon Dioxide
Capnography; Cardiopulmonary arrest; Cardiopulmonary resuscitation