The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest

Aleksandra A. Abrahamowicz; Catherine R. Counts; Kyle R. Danielson; Natalie E. Bulger; Charles Maynard; David J. Carlbom; Erik R. Swenson; Andrew J. Latimer; Betty Yang; Michael R. Sayre; Nicholas J. Johnson

doi:10.1016/j.resuscitation.2022.09.019

The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest

Aleksandra A. Abrahamowicz, Catherine R. Counts, Kyle R. Danielson, Natalie E. Bulger, Charles Maynard, David J. Carlbom, Erik R. Swenson, Andrew J. Latimer, Betty Yang, Michael R. Sayre, Nicholas J. Johnson

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Aim: We sought to determine if the difference between P_aCO₂ and E_TCO₂ is associated with hospital mortality and neurologic outcome following out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study of adult patients who achieved return of spontaneous circulation (ROSC) after OHCA over 3 years. The primary exposure was the P_aCO₂-E_TCO₂ difference on hospital arrival. The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurologic status at discharge. We used receiver operating characteristic (ROC) curves to determine discrimination threshold and multivariate logistic regression to examine the association between the P_aCO₂-E_TCO₂ difference and outcome. Results: Of 698 OHCA patients transported to the hospitals, 381 had sustained ROSC and qualifying E_TCO₂ and P_aCO₂ values. Of these, 160 (42%) survived to hospital discharge. Mean E_TCO₂ was 39 mmHg among survivors and 43 mmHg among non-survivors. Mean P_aCO₂-E_TCO₂ was 6.8 mmHg and 9.0 mmHg (p < 0.05) for survivors and non-survivors. After adjustment for Utstein characteristics, a higher P_aCO₂-E_TCO₂ difference on hospital arrival was not associated with hospital mortality (OR 0.99, 95% CI: 0.97–1.0) or neurological outcome. Area under the ROC curve or P_aCO₂-E_TCO₂ difference was 0.56 (95% CI 0.51–0.62) compared with 0.58 (95% CI 0.52–0.64) for E_TCO₂. Conclusion: Neither P_aCO₂-E_TCO₂ nor E_TCO₂ were strong predictors of survival or neurologic status at hospital discharge. While they may be useful to guide ventilation and resuscitation, these measures should not be used for prognostication after OHCA.

Original language	English (US)
Pages (from-to)	3-9
Number of pages	7
Journal	Resuscitation
Volume	181
DOIs	https://doi.org/10.1016/j.resuscitation.2022.09.019
State	Published - Dec 2022
Externally published	Yes

Keywords

Arterial carbon dioxide
Cardiac arrest
End tidal carbon dioxide
OHCA
Out-of-hospital cardiac arrest

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2022.09.019

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Abrahamowicz, A. A., Counts, C. R., Danielson, K. R., Bulger, N. E., Maynard, C., Carlbom, D. J., Swenson, E. R., Latimer, A. J., Yang, B., Sayre, M. R., & Johnson, N. J. (2022). The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest. Resuscitation, 181, 3-9. https://doi.org/10.1016/j.resuscitation.2022.09.019

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title = "The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest",

abstract = "Aim: We sought to determine if the difference between PaCO2 and ETCO2 is associated with hospital mortality and neurologic outcome following out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study of adult patients who achieved return of spontaneous circulation (ROSC) after OHCA over 3 years. The primary exposure was the PaCO2-ETCO2 difference on hospital arrival. The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurologic status at discharge. We used receiver operating characteristic (ROC) curves to determine discrimination threshold and multivariate logistic regression to examine the association between the PaCO2-ETCO2 difference and outcome. Results: Of 698 OHCA patients transported to the hospitals, 381 had sustained ROSC and qualifying ETCO2 and PaCO2 values. Of these, 160 (42%) survived to hospital discharge. Mean ETCO2 was 39 mmHg among survivors and 43 mmHg among non-survivors. Mean PaCO2-ETCO2 was 6.8 mmHg and 9.0 mmHg (p < 0.05) for survivors and non-survivors. After adjustment for Utstein characteristics, a higher PaCO2-ETCO2 difference on hospital arrival was not associated with hospital mortality (OR 0.99, 95% CI: 0.97–1.0) or neurological outcome. Area under the ROC curve or PaCO2-ETCO2 difference was 0.56 (95% CI 0.51–0.62) compared with 0.58 (95% CI 0.52–0.64) for ETCO2. Conclusion: Neither PaCO2-ETCO2 nor ETCO2 were strong predictors of survival or neurologic status at hospital discharge. While they may be useful to guide ventilation and resuscitation, these measures should not be used for prognostication after OHCA.",

keywords = "Arterial carbon dioxide, Cardiac arrest, End tidal carbon dioxide, OHCA, Out-of-hospital cardiac arrest",

author = "Abrahamowicz, {Aleksandra A.} and Counts, {Catherine R.} and Danielson, {Kyle R.} and Bulger, {Natalie E.} and Charles Maynard and Carlbom, {David J.} and Swenson, {Erik R.} and Latimer, {Andrew J.} and Betty Yang and Sayre, {Michael R.} and Johnson, {Nicholas J.}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = dec,

doi = "10.1016/j.resuscitation.2022.09.019",

language = "English (US)",

volume = "181",

pages = "3--9",

journal = "Resuscitation",

issn = "0300-9572",

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TY - JOUR

T1 - The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest

AU - Abrahamowicz, Aleksandra A.

AU - Counts, Catherine R.

AU - Danielson, Kyle R.

AU - Bulger, Natalie E.

AU - Maynard, Charles

AU - Carlbom, David J.

AU - Swenson, Erik R.

AU - Latimer, Andrew J.

AU - Yang, Betty

AU - Sayre, Michael R.

AU - Johnson, Nicholas J.

PY - 2022/12

Y1 - 2022/12

N2 - Aim: We sought to determine if the difference between PaCO2 and ETCO2 is associated with hospital mortality and neurologic outcome following out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study of adult patients who achieved return of spontaneous circulation (ROSC) after OHCA over 3 years. The primary exposure was the PaCO2-ETCO2 difference on hospital arrival. The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurologic status at discharge. We used receiver operating characteristic (ROC) curves to determine discrimination threshold and multivariate logistic regression to examine the association between the PaCO2-ETCO2 difference and outcome. Results: Of 698 OHCA patients transported to the hospitals, 381 had sustained ROSC and qualifying ETCO2 and PaCO2 values. Of these, 160 (42%) survived to hospital discharge. Mean ETCO2 was 39 mmHg among survivors and 43 mmHg among non-survivors. Mean PaCO2-ETCO2 was 6.8 mmHg and 9.0 mmHg (p < 0.05) for survivors and non-survivors. After adjustment for Utstein characteristics, a higher PaCO2-ETCO2 difference on hospital arrival was not associated with hospital mortality (OR 0.99, 95% CI: 0.97–1.0) or neurological outcome. Area under the ROC curve or PaCO2-ETCO2 difference was 0.56 (95% CI 0.51–0.62) compared with 0.58 (95% CI 0.52–0.64) for ETCO2. Conclusion: Neither PaCO2-ETCO2 nor ETCO2 were strong predictors of survival or neurologic status at hospital discharge. While they may be useful to guide ventilation and resuscitation, these measures should not be used for prognostication after OHCA.

AB - Aim: We sought to determine if the difference between PaCO2 and ETCO2 is associated with hospital mortality and neurologic outcome following out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study of adult patients who achieved return of spontaneous circulation (ROSC) after OHCA over 3 years. The primary exposure was the PaCO2-ETCO2 difference on hospital arrival. The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurologic status at discharge. We used receiver operating characteristic (ROC) curves to determine discrimination threshold and multivariate logistic regression to examine the association between the PaCO2-ETCO2 difference and outcome. Results: Of 698 OHCA patients transported to the hospitals, 381 had sustained ROSC and qualifying ETCO2 and PaCO2 values. Of these, 160 (42%) survived to hospital discharge. Mean ETCO2 was 39 mmHg among survivors and 43 mmHg among non-survivors. Mean PaCO2-ETCO2 was 6.8 mmHg and 9.0 mmHg (p < 0.05) for survivors and non-survivors. After adjustment for Utstein characteristics, a higher PaCO2-ETCO2 difference on hospital arrival was not associated with hospital mortality (OR 0.99, 95% CI: 0.97–1.0) or neurological outcome. Area under the ROC curve or PaCO2-ETCO2 difference was 0.56 (95% CI 0.51–0.62) compared with 0.58 (95% CI 0.52–0.64) for ETCO2. Conclusion: Neither PaCO2-ETCO2 nor ETCO2 were strong predictors of survival or neurologic status at hospital discharge. While they may be useful to guide ventilation and resuscitation, these measures should not be used for prognostication after OHCA.

KW - Arterial carbon dioxide

KW - Cardiac arrest

KW - End tidal carbon dioxide

KW - OHCA

KW - Out-of-hospital cardiac arrest

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M3 - Article

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AN - SCOPUS:85140797569

SN - 0300-9572

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EP - 9

JO - Resuscitation

JF - Resuscitation

ER -

The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest

Abstract

Keywords

ASJC Scopus subject areas

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