Hartmann Silvia M, Farris Reid W D, Di Gennaro Jane L, Roberts Joan S
Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA.
J Intensive Care Med. 2015 Oct;30(7):426-35. doi: 10.1177/0885066614530839. Epub 2014 Apr 22.
End-tidal carbon dioxide (ETCO(2)) measurements during cardiopulmonary resuscitation (CPR) reflect variable cardiac output over time, and low values have been associated with decreased survival. The goals of this review are to confirm and quantify this relationship and to determine the mean ETCO(2) value among patients with return of spontaneous circulation (ROSC) as an initial step toward determining an appropriate target for intervention during resuscitation in the absence of prospective data.
The PubMed database was searched for the key words "end-tidal carbon dioxide" or "capnometry" or "capnography" and "resuscitation" or "return of spontaneous circulation." Randomized controlled trials, cohort studies, or case-control studies that reported ETCO(2) values for participants with and without ROSC were included.
Twenty-seven studies met the inclusion criteria for qualitative synthesis. Twenty studies were included in determination of average ETCO(2) values. The mean ETCO(2) in participants with ROSC was 25.8 ± 9.8 mm Hg versus 13.1 ± 8.2 mm Hg (P = .001) in those without ROSC. Nineteen studies were included in a meta-analysis. The mean difference in ETCO(2) was 12.7 mm Hg (95% confidence interval: 10.3-15.1) between participants with and without ROSC (P < .001). The mean difference in ETCO(2) was not modified by the receipt of sodium bicarbonate, uncontrolled minute ventilation, or era of resuscitation guidelines. The overall quality of data by Grades of Recommendations, Assessment, Development and Evaluation criteria is very low, but no prospective data are currently available.
Participants with ROSC after CPR have statistically higher levels of ETCO(2). The average ETCO(2) level of 25 mm Hg in participants with ROSC is notably higher than the threshold of 10 to 20 mm Hg to improve delivery of chest compressions. The ETCO(2) goals during resuscitation may be higher than previously suggested and further investigation into appropriate targets during resuscitation is needed to diminish morbidity and mortality after cardiorespiratory arrest.
心肺复苏（CPR）期间的呼气末二氧化碳（ETCO₂）测量反映了随时间变化的心输出量，低值与生存率降低相关。本综述的目的是确认并量化这种关系，并确定自主循环恢复（ROSC）患者的平均ETCO₂值，作为在缺乏前瞻性数据的情况下确定复苏期间合适干预目标的第一步。
在PubMed数据库中搜索关键词“呼气末二氧化碳”或“二氧化碳测定法”或“二氧化碳描记法”以及“复苏”或“自主循环恢复”。纳入报告了有和没有ROSC的参与者的ETCO₂值的随机对照试验、队列研究或病例对照研究。
27项研究符合定性综合的纳入标准。20项研究被纳入平均ETCO₂值的测定。有ROSC的参与者的平均ETCO₂为25.8±9.8 mmHg，而没有ROSC的参与者为13.1±8.2 mmHg（P = 0.001）。19项研究被纳入荟萃分析。有和没有ROSC的参与者之间ETCO₂的平均差异为12.7 mmHg（95%置信区间：10.3 - 15.1）（P < 0.001）。ETCO₂的平均差异不受碳酸氢钠的使用、未控制的分钟通气或复苏指南时代的影响。根据推荐分级、评估、制定和评价标准，数据的总体质量非常低，但目前没有前瞻性数据。
CPR后有ROSC的参与者的ETCO₂水平在统计学上更高。有ROSC的参与者的平均ETCO₂水平25 mmHg明显高于改善胸外按压效果的10至20 mmHg阈值。复苏期间的ETCO₂目标可能高于先前建议的水平，需要进一步研究复苏期间的合适目标以降低心肺骤停后的发病率和死亡率。
