Pulmonary vascular disease & thromboembolism
Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism
Main finding · Elevated CO2 gap (>6 mmHg)Result — go to the resultOdds ratio 7.9 95% CI 3.49–18.1Authors' conclusion
Among patients with acute PE undergoing mechanical thrombectomy, the CO2 gap is abnormal in nearly 50% of patients and inversely related to the CI.
Study context
- Population
- Patients with acute pulmonary embolism (PE) undergoing mechanical thrombectomy and simultaneous pulmonary artery catheterization over a 3-year period97 with blood gases
- Participants
- 107 patients
- Exposure
- CO2 gap >6 mmHg vs CO2 gap ≤6 mmHg
- Outcome
- Mixed venous-to-arterial CO2 gradient (CO2 gap), a surrogate of perfusion adequacy
Methodological detailssingle-centre, consecutive patients
- Single-centre
- Consecutive patients
Main finding
Elevated CO2 gap (>6 mmHg)
Odds ratio
7.9
95% CI 3.49–18.1
P < 0.001
Reduced CI (≤2.2 L/min/m²)
OR 7.9 (95% CI 3.49–18.1); P < 0.001
As reported in the abstract
- CO2 gap elevated (>6 mmHg) in whole cohort
- 51%
- CO2 gap elevated in intermediate-risk PE
- 49%
- CO2 gap increase per 1 L/min/m² decrease in CI (inverse relationship)
- 1.3 mmHg (P = 0.001)
Observational data: associations, not effects.
Further findings
| Outcome | Above 6 | Below 6 | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| In-hospital mortality, by CO2 gap dichotomised above vs below 69 vs. 0%; P = 0.10 | 9% | 0% | 1.24 (0.97–1.60) | P = 0.085 | |
| 0.512Hazard ratio (log scale) |
Elevated CO2 gap (>6 mmHg), intermediate-risk PE (subgroup)
- Elevated CO2 gap (>6 mmHg) in intermediate-risk PE
- 49%
In-hospital mortality, by CO2 gap dichotomised above vs below 6
- No difference in in-hospital mortality
Change after thrombectomy in patients with elevated baseline CO2 gap >6 mmHg
- Thrombectomy improved CO2 gap, CI and mixed venous oxygen saturation
Original publication
Relationship between the mixed venous-to-arterial carbon dioxide gradient and the cardiac index in acute pulmonary embolism. Eur Heart J Acute Cardiovasc Care. Published 8 March 2024. doi:10.
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