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Resuscitation. 2018 Dec;133:173-179. doi: 10.1016/j.resuscitation.2018.08.013. Epub 2018 Aug 15.

End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation.

Author information

1
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States. Electronic address: bergra@email.chop.edu.
2
Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84158, United States.
3
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Blvd, Detroit, MI 48201, United States.
4
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, 611 East Livingston Ave, Columbus, OH 43205, United States.
5
Department of Pediatrics, Children's National Medical Center, 111 Michigan Ave, NW, Washington DC 20010, United States.
6
Department of Anesthesiology, Children's Hospital of Los Angeles, University of Southern California Keck College of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033, United States.
7
Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, 4401 Penn. Ave, Pittsburgh, PA 15224, United States.
8
Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, 1550 4th Street, San Francisco, CA 94158, United States.
9
Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States.
10
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, 1540 E Hospital Drive, Ann Arbor, MI 48109, United States.
11
Department of Pediatrics, Children's National Medical Center, 111 Michigan Ave, NW, Washington DC 20010, United States; Department of Pediatrics, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, United States.
12
Department of Pediatrics, Children's Hospital of Colorado, 13121 East 17th Avenue, University of Colorado, Denver, CO 80045, United States.
13
Department of Molecular Biology, Princeton University, 219 Lewis Thomas Lab, Princeton, NJ 08544, United States.
14
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.

Abstract

BACKGROUND:

Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) >20 mmHg.

AIMS:

We prospectively evaluated whether ETCO2 > 20 mmHg during CPR was associated with survival to hospital discharge.

METHODS:

Children ≥37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 min and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. ETCO2 and Utstein-style cardiac arrest data were collected. Multivariable Poisson regression models with robust error estimates were used to estimate relative risk of outcomes.

RESULTS:

Blinded investigators analyzed ETCO2 waveforms from 43 children. During CPR, the median ETCO2 was 23 mmHg [quartiles, 16 and 28 mmHg], median ventilation rate was 29 breaths/min [quartiles, 24 and 35 breaths/min], and median duration of CPR was 5 min [quartiles, 2 and 16 min]. Return of spontaneous circulation occurred after 71% of CPR events and 37% of patients survived to hospital discharge. For children with mean ETCO2 during CPR > 20 mmHg, the adjusted relative risk for survival was 0.92 (0.41, 2.08), p = 0.84. The median mean ETCO2 among children who survived to hospital discharge was 20 mmHg [quartiles; 15, 28 mmHg] versus 23 mmHg [16, 28 mmHg] among non-survivors.

CONCLUSION:

Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with survival to hospital discharge, and ETCO2 was not different in survivors versus non-survivors.

KEYWORDS:

Cardiac arrest; Cardiopulmonary resuscitation (CPR); End-tidal carbon dioxide (ETCO2); In-hospital; Pediatric; Survival

PMID:
30118812
PMCID:
PMC6258346
[Available on 2019-12-01]
DOI:
10.1016/j.resuscitation.2018.08.013

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