Acute cardiac care & resuscitationCohort study
Associations Between End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality, and Survival
- Prospective observational cohort study
- ancillary study of the ICU-RESUS trial
- multicentre
Authors' conclusion
In this multicenter study of children with in-hospital cardiopulmonary arrest, ETCO2 ≥20 mm Hg was associated with better outcomes and higher intra-arrest blood pressures, but not with chest compression quality metrics.
Study context
- Population
- Hospitalised children (≤18 years, ≥37 weeks postgestational age) receiving chest compressions for cardiopulmonary arrest with an endotracheal or tracheostomy tube and evaluable intra-arrest ETCO2
- Participants
- 234 children
- Exposure
- Average ETCO2 ≥20 mm Hg vs <20 mm Hg during first 10 min of cardiopulmonary resuscitation (CPR)
- ETCO2 ≥20 mm Hgn = 133
- ETCO2 <20 mm Hgn = 101reference
- Outcome
- Survival to hospital discharge
- Follow-up
- Hospital discharge
Main finding
As reported in the abstract
Adjusted relative risk
1.33
95% CI 1.04–1.69
P = 0.023
Events by group
ETCO2 ≥20 mm Hg vs ETCO2 <20 mm Hg
adjusted RR 1.33 (95% CI 1.04–1.69); P = 0.023
Observational data: associations, not effects.
Secondary outcomes
| Outcome | ETCO2 ≥20 mm Hg | ETCO2 <20 mm Hg | adjusted RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Return of spontaneous circulation | 71% | 58% | 1.22 (1.00–1.49) | P = 0.046 | |
| 0.512Adjusted relative risk (log scale) |
Survival with favourable neurological outcome; new morbidity among survivors
- ETCO2 ≥20 mm Hg not associated with survival with favourable neurological outcome or new morbidity among survivors
Intra-arrest BP and CPR characteristics
- ETCO2 ≥20 mm Hg associated with higher SBP and DBP during CPR, lower ventilation rates and briefer pre-CPR arrest durations
- Chest compression rate, depth and fraction did not differ between ETCO2 groups
Original publication
Associations Between End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality, and Survival. Circulation. Published 6 November 2023. doi:10.1161/circulationaha.123.066659
Summarised from the published abstract; every number is checked against it