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End Tidal Carbon Dioxide (EtCO2) Concentration, as a Predictor of Mortality and Morbidity among Patients Resuscitated in the Emergency Department

Shahid Mustafa Khan, Consultant, Dept. of Emergency Medicine, National Health Service (NHS), England, United Kingdom. , Kishalay Datta , Shahid Mustafa Khan

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Indian Journal of Emergency Medicine 4(3):p 155-160, Jul-Sep, 2018. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.7

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Abstract

Traditionally, post resuscitation phase in the emergency department concentrates on the normalization of easily demonstrable vital signs such as heart rate, mean arterial pressure (MAP) and central venous pressure. The ultimate end point of all resuscitative measures is to achieve adequate tissue oxygenation and perfusion. However, it has been studied that these demonstrable vital signs are poor indicators of tissue level oxygenation and perfusion in the critically ill patients [1,2]. Capnography is measurement of the concentration of carbon dioxide (CO2) at the end of each exhaled breath, commonly known as the end-tidal carbon dioxide (EtCO2). It is a fast, noninvasive, and relatively inexpensive monitoring tool. EtCO2 levels have been shown to be independently predictive of the patient’s clinical status (9). In this study, we aim to record the EtCO2 levels immediately after tracheal intubation and study if the subsequent trends in EtCO2 levels can predict patient outcome in terms of morbidity (length of ICU stay, duration of mechanical ventilation, total duration of hospital stay) and mortality.

Methods and Material: The study was conducted after approval from the institutional Scientific and Ethical committee. It was a prospective observational study; where in data was collected prospectively with no interventions on behalf of the investigator. For the purpose of statistical significance we have chosen to recruit eighty seven patients based on the results and statistical analysis from previous studies. The data collected was analyzed using specified statistical methods to derive association between the various study parameters under consideration.

Statistical analysis used: Based on the results of a previous study (12), the mortality of these patients is (28/36) equal to 0.78, the specificity of EtCO2 for mortality was observed to be 42.8% in the same subjects. Using these values, the sample size for detecting a minimum difference of 4% in specificity is 31, with power 80% and level of significance 5%. For the purpose of our study we choose to recruit a sample size of  Eighty seven.

Conclusions: Based on the results of previous studies and the results of our study it becomes imperative that EtCO2 levels strongly predict survival in patients resuscitated in the emergency department, patients who fail to attain a higher EtCO2 level (average mean 15 mm Hg at 0 min) post resuscitation have poorer outcomes in terms of survival.

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.7

Keywords

End-Tidal Carbon Dioxide (Etco2); Intubation; Capnography; Morbidity.

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