• Bartholomew Grabman, Natalie E Bulger, Brenna M Harrington, Robert G Walker, Andrew J Latimer, Bonnie D Snyder, Michael R Sayre, Charles Maynard, Nicholas J Johnson, Molly Van Dyke, and Catherine R Counts.
• University of New Mexico School of Medicine, United States. Electronic address: BGrabman@salud.unm.edu.
• Resuscitation. 2022 Dec 1; 181: 485448-54.

IntroductionGuidelines recommend monitoring end-tidal carbon dioxide (ETCO2) during out-of-hospital cardiac arrest (OHCA), though its prognostic value is poorly understood. This study investigated the relationship between ETCO2 and return of spontaneous circulation (ROSC) after defibrillation in intubated non-traumatic OHCA patients.MethodsThis retrospective, observational cohort analysis included adult OHCA patients who received a defibrillation shock during treatment by an urban EMS agency from 2015 to 2021. Peak ETCO2 values were determined for the 90-second periods before and after the first defibrillation in an intubated patient (shock of interest [SOI]). Values were analyzed for association between the change in ETCO2 from pre- to post-shock and the presence of ROSC on the subsequent pulse check.ResultsOf 518 eligible patients, mean age was 61, 72% were male, 50% had a bystander-witnessed arrest, and 62% had at least one episode of ROSC. The most common arrest etiology was medical (92%). Among all patients, peak ETCO2 during resuscitation prior to SOI was 36.8 mmHg (18.6). ETCO2 increased in patients who achieved ROSC immediately after SOI (from 38.3 to 47.6 mmHg; +9.3 CI: 6.5, 12.1); patients with sustained ROSC experienced the greatest increase in ETCO2 after SOI (from 37.8 to 48.2 mmHg; +10.4 CI: 7.2, 13.6), while ETCO2 in patients who did not achieve ROSC after SOI rose (from 36.4 to 37.8 mmHg; +1.4 CI: -0.1, 2.8).ConclusionsETCO2 rises after defibrillation in most patients during cardiac arrest. Patients with sustained ROSC experience larger rises, though the majority experience rises of less than 10 mmHg.Copyright © 2022. Published by Elsevier B.V.

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