Background Survival after cardiac arrest occurring outside thehospital averages less than 3 percent. Unfortunately, the outcomeof prolonged resuscitative attempts cannot be predicted. End-tidalcarbon dioxide levels reflect cardiac output during cardiopulmonaryresuscitation. We prospectively determined whether death couldbe predicted by monitoring end-tidal carbon dioxide during resuscitationafter cardiac arrest.
Methods We performed a prospective observational study in 150consecutive victims of cardiac arrest outside the hospital whohad electrical activity but no pulse. The patients were intubatedand evaluated by mainstream end-tidal carbon dioxide monitoring.Our hypothesis was that an end-tidal carbon dioxide level of10 mm Hg or less after 20 minutes of standard advanced cardiaclife support would predict death.
Results There was no difference in the mean age or initial end-tidalcarbon dioxide level between patients who survived to hospitaladmission (survivors) and those who did not (nonsurvivors).After 20 minutes of advanced cardiac life support, end-tidalcarbon dioxide (±SD) averaged 4.4±2.9 mm Hg innonsurvivors and 32.8±7.4 mm Hg in survivors (P< 0.001).A 20-minute end-tidal carbon dioxide value of 10 mm Hg or lesssuccessfully discriminated between the 35 patients who survivedto hospital admission and the 115 nonsurvivors. When a 20-minuteend-tidal carbon dioxide value of 10 mm Hg or less was usedas a screening test to predict death, the sensitivity, specificity,positive predictive value, and negative predictive value wereall 100 percent.
Conclusions An end-tidal carbon dioxide level of 10 mm Hg orless measured 20 minutes after the initiation of advanced cardiaclife support accurately predicts death in patients with cardiacarrest associated with electrical activity but no pulse. Cardiopulmonaryresuscitation may reasonably be terminated in such patients.
Source Information
From the Department of Medicine, Divisions of Pulmonary, Critical Care, and Emergency Medicine (R.L.L.), and the Department of Surgery (C.C.M.), Baylor College of Medicine, Houston; and the City of Bellingham Emergency Medical Services, Bellingham, Wash. (M.A.W.).
Address reprint requests to Dr. Wayne at Emergency Medical Services, 1800 Broadway, Bellingham, WA 98225.
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