End-tidal carbon dioxide on emergency department arrival predicts trauma patient need for transfusion, vasopressors, and operative hemorrhage control in the first 24 hours

Abstract

Introduction: Predicting early need for trauma resuscitation is an important goal of trauma systems. Aim/Hypothesis: We sought to compare the predictive value of end-tidal carbon dioxide (EtCO2) compared to hemoglobin, shock index, systolic blood pressure, heart rate, and respiratory rate in determining transfusion requirement, need for operative hemorrhage control, or pressor use in the first 24 h after trauma alert activation. Materials and Methods: A convenience sample of trauma patients at a Level 1 community trauma center were enrolled. EtCO2 was measured via nasal cannula upon arrival, in addition to initial hemoglobin levels and vital signs. Once stable and competent, patients or families were consented. EtCO2 average over three measurements 3 min apart was used as the EtCO2 value. The electronic medical record was reviewed by a trained research associate who was not involved in the care of the patient to determine the need for transfusion, pressor use, or operative hemorrhage control within the first 24 h of hospitalization. Results: Fifty patients were enrolled, with a median age of 52 years. Seven patients required transfusion, pressor use, and/or surgical hemorrhage control. Vital signs between groups were statistically no different. The mean EtCO2 in patients requiring transfusion was 26.8 (19.5–34.1) versus 34.1 (31.8–36.3) in those who did not (P = 0.027). A cutoff value of EtCO2 ≤33 mmHg was 100% sensitive and 62.8% specific, with an area under the curve of 0.889. Conclusion: EtCO2 has a high sensitivity in predicting the need for intervention in trauma patients. Additional research is needed to determine further utility of this value in the triage and treatment of trauma patients. The following core competency statement: Patient care and Systems-based practice.