Abstract
Aim: The carbon dioxide gap or ΔCO2 is the difference between the partial pressure of carbon dioxide
 (pCO2 ) and end-tidal carbon dioxide (ETCO2 ), which should normally not exceed 3-5mmHg. In critically ill
 patients ΔCO2 increases as a result of decreased cardiac output and pulmonary blood flow compromise.
 The primary outcome of this study is to examine the diagnostic accuracy of ΔCO2 in predicting the return
 of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients.
 Material and Methods: Non-traumatic OHCA patients over 18 years of age were included in this
 prospective observational study. ETCO2 values were recorded 1 minute after the intubation and arterial
 blood gas samples were acquired simutaneously. The difference between the initial ΔCO2 medians of
 the ROSC+ and ROSC- patient groups were analyzed and the diagnostic test performance in predicting
 ROSC of ΔCO2 was calculated. A regression model was performed to accurately predict ROSC in
 OHCA patients.
 Results: A total of 46 patients were included to the inal analysis. The ΔCO2 median of the ROSC+ group
 was significantly lower than the ROSC- group (p=0.026, 95%CI:-31 to-3). Area under the curve was
 calculated as 0.694 (95%CI: 0.532 to 0.855), sensitivity 76.19% (95%CI:52.83 to 91.78%), specificity
 76% (95%CI:54.87 to 90.64), and accuracy 76.09% (95%CI:61.23% to87.41%) for the optimal cut-off
 value (51.4 mmHg). The regression model consists of age, initial ETCO2 , and initial cardiac rhythm
 showed good discrimination in predicting ROSC (AUC=0.846, 95%CI=0.735 to 0.956, p
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