Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Resuscitation. 2012 Jul;83(7):813-8. doi: 10.1016/j.resuscitation.2012.02.021. Epub 2012 Feb 25.
End tidal carbon dioxide (ETCO(2)) monitoring during advanced life support (ALS) using capnography, is recommended in the latest international guidelines. However, several factors might complicate capnography interpretation during ALS. How the cause of cardiac arrest, initial rhythm, bystander cardiopulmonary resuscitation (CPR) and time impact on the ETCO(2) values are not completely clear. Thus, we wanted to explore this in out-of-hospital cardiac arrested (OHCA) patients.
The study was carried out by the Emergency Medical Service of Haukeland University Hospital, Bergen, Norway. All non-traumatic OHCAs treated by our service between January 2004 and December 2009 were included. Capnography was routinely used in the study, and these data were retrospectively reviewed together with Utstein data and other clinical information.
Our service treated 918 OHCA patients, and capnography data were present in 575 patients. Capnography distinguished well between patients with or without return of spontaneous circulation (ROSC) for any initial rhythm and cause of the arrest (p<0.001). Cardiac arrests with a respiratory cause had significantly higher levels of ETCO(2) compared to primary cardiac causes (p<0.001). Bystander CPR affected ETCO(2)-recordings, and the ETCO(2) levels declined with time.
Capnography is a useful tool to optimise and individualise ALS in cardiac arrested patients. Confounding factors including cause of cardiac arrest, initial rhythm, bystander CPR and time from cardiac arrest until quantitative capnography had an impact on the ETCO(2) values, thereby complicating and limiting prognostic interpretation of capnography during ALS.
在高级生命支持（ALS）期间使用呼气末二氧化碳（ETCO₂）监测，在最新的国际指南中被推荐。然而，在 ALS 期间，有几个因素可能会使二氧化碳描记法的解释变得复杂。心搏骤停的原因、初始节律、旁观者心肺复苏（CPR）和时间对 ETCO₂值的影响尚不完全清楚。因此，我们希望在院外心搏骤停（OHCA）患者中探讨这一问题。
本研究由挪威卑尔根哈康大学医院的紧急医疗服务部门进行。纳入 2004 年 1 月至 2009 年 12 月期间由我们服务治疗的所有非创伤性 OHCA 患者。该研究常规使用二氧化碳描记法，回顾性地审查这些数据以及乌斯泰因数据和其他临床信息。
我们的服务共治疗了 918 例 OHCA 患者，其中 575 例患者有二氧化碳描记法数据。二氧化碳描记法很好地区分了任何初始节律和心搏骤停原因的患者是否有自主循环恢复（ROSC）（p<0.001）。呼吸原因引起的心搏骤停的 ETCO₂水平明显高于原发性心脏原因引起的心搏骤停（p<0.001）。旁观者 CPR 影响了 ETCO₂记录，ETCO₂水平随时间下降。
二氧化碳描记法是优化和个体化心脏骤停患者 ALS 的有用工具。混杂因素包括心搏骤停的原因、初始节律、旁观者 CPR 和从心搏骤停到定量二氧化碳描记法的时间，这些因素影响了 ETCO₂值，从而使 ALS 期间二氧化碳描记法的预后解释变得复杂和受限。
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