298 End-Tidal Carbon Dioxide Monitoring and the Possibility of Return of Spontaneous Circulation During Out-of-Hospital Cardiac Arrest: A Population-Based Study

Abstract

BackgroundEnd-tidal carbon dioxide (ETCO2) monitoring is recommended as a chest compression performance indicator during cardiac arrest. However, the frequency of use during out-of-hospital cardiac arrest (OHCA) and its benefits have never been evaluated in real clinical situations.Study ObjectiveWe investigated OHCA patients in Taiwan to evaluate the frequency of ETCO2 use and the effects on return of spontaneous circulation (ROSC).MethodsWe utilized a sampled National Health Insurance claims database containing one million beneficiaries. All adult beneficiaries older than 18 years presented with OHCA and received chest compression between January 1, 2005 and December 31, 2012 were enrolled. We further identified patients with ETCO2 use and matched each one with twenty patients without ETCO2 use based on their propensity scores. The Logistic regression model was applied to compare the odds ratios (ORs) of ROSC in the matched cohorts.ResultsA total of 5041 OHCA patients were enrolled. The frequency of ETCO2 use is increased after 2010 but still is low. After matching, 59 patients with ETCO2 use and 1180 without were selected. The adjusted OR of ROSC is significantly increased (2.89; 95% CI 1.53-5.48).ConclusionPatients with ETCO2 use may benefit from better chest compression performance which in turn results in higher possibility of ROSC. However, the overall use of ETCO2 is still low despite strong recommendation in the guidelines. BackgroundEnd-tidal carbon dioxide (ETCO2) monitoring is recommended as a chest compression performance indicator during cardiac arrest. However, the frequency of use during out-of-hospital cardiac arrest (OHCA) and its benefits have never been evaluated in real clinical situations. End-tidal carbon dioxide (ETCO2) monitoring is recommended as a chest compression performance indicator during cardiac arrest. However, the frequency of use during out-of-hospital cardiac arrest (OHCA) and its benefits have never been evaluated in real clinical situations. Study ObjectiveWe investigated OHCA patients in Taiwan to evaluate the frequency of ETCO2 use and the effects on return of spontaneous circulation (ROSC). We investigated OHCA patients in Taiwan to evaluate the frequency of ETCO2 use and the effects on return of spontaneous circulation (ROSC). MethodsWe utilized a sampled National Health Insurance claims database containing one million beneficiaries. All adult beneficiaries older than 18 years presented with OHCA and received chest compression between January 1, 2005 and December 31, 2012 were enrolled. We further identified patients with ETCO2 use and matched each one with twenty patients without ETCO2 use based on their propensity scores. The Logistic regression model was applied to compare the odds ratios (ORs) of ROSC in the matched cohorts. We utilized a sampled National Health Insurance claims database containing one million beneficiaries. All adult beneficiaries older than 18 years presented with OHCA and received chest compression between January 1, 2005 and December 31, 2012 were enrolled. We further identified patients with ETCO2 use and matched each one with twenty patients without ETCO2 use based on their propensity scores. The Logistic regression model was applied to compare the odds ratios (ORs) of ROSC in the matched cohorts. ResultsA total of 5041 OHCA patients were enrolled. The frequency of ETCO2 use is increased after 2010 but still is low. After matching, 59 patients with ETCO2 use and 1180 without were selected. The adjusted OR of ROSC is significantly increased (2.89; 95% CI 1.53-5.48). A total of 5041 OHCA patients were enrolled. The frequency of ETCO2 use is increased after 2010 but still is low. After matching, 59 patients with ETCO2 use and 1180 without were selected. The adjusted OR of ROSC is significantly increased (2.89; 95% CI 1.53-5.48). ConclusionPatients with ETCO2 use may benefit from better chest compression performance which in turn results in higher possibility of ROSC. However, the overall use of ETCO2 is still low despite strong recommendation in the guidelines. Patients with ETCO2 use may benefit from better chest compression performance which in turn results in higher possibility of ROSC. However, the overall use of ETCO2 is still low despite strong recommendation in the guidelines.