Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Am J Emerg Med. 2019 Jan;37(1):1-4. doi: 10.1016/j.ajem.2018.04.025. Epub 2018 Apr 14.
We investigated the predictive value of the gradient between arterial carbon dioxide (PaCO) and end-tidal carbon dioxide (ETCO) (Pa-ETCO) in post-cardiac arrest patients for in-hospital mortality.
This retrospective observational study evaluated cardiac arrest patients admitted to the emergency department of a tertiary university hospital. The PaCO and ETCO values at 6, 12, and 24 h after return of spontaneous circulation (ROSC) were obtained from medical records and Pa-ETCO gap was calculated as the difference between PaCO and ETCO at each time point. Multivariate logistic regression analysis was performed to verify the relationship between Pa-ETCO gap and clinical variables. Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of Pa-ETCO for predicting in-hospital mortality.
The final analysis included 58 patients. In univariate analysis, Pa-ETCO gaps were significantly lower in survivors than in non-survivors at 12 h [12.2 (6.5-14.8) vs. 13.9 (12.1-19.6) mmHg, p = 0.040] and 24 h [9.1 (6.3-10.5) vs. 17.1 (13.1-23.2) mmHg, p < 0.001)] after ROSC. In multivariate analysis, Pa-ETCO gap at 24 h after ROSC was related to in-hospital mortality [odds ratio (95% confidence interval): 1.30 (1.07-1.59), p = 0.0101]. In ROC curve analysis, the optimal cut-off value of Pa-ETCO gap at 24 h after ROSC was 10.6 mmHg (area under the curve, 0.843), with 77.8% sensitivity and 85.7% specificity.
The Pa-ETCO gap at 24 h after ROSC was associated with in-hospital mortality in post-cardiac arrest patients.
我们研究了心肺复苏后患者动脉二氧化碳（PaCO）与呼气末二氧化碳（ETCO）之间梯度（Pa-ETCO）对院内死亡率的预测价值。
本回顾性观察性研究评估了入住三级大学医院急诊科的心脏骤停患者。从病历中获取自主循环恢复（ROSC）后 6、12 和 24 小时的 PaCO 和 ETCO 值，并计算每个时间点的 Pa-ETCO 差值。采用多变量逻辑回归分析验证 Pa-ETCO 差值与临床变量之间的关系。进行受试者工作特征（ROC）曲线分析，以确定 Pa-ETCO 预测院内死亡率的截断值。
最终分析包括 58 例患者。在单因素分析中，幸存者在 ROSC 后 12 小时[12.2（6.5-14.8）比 13.9（12.1-19.6）mmHg，p=0.040]和 24 小时[9.1（6.3-10.5）比 17.1（13.1-23.2）mmHg，p<0.001]的 Pa-ETCO 差值明显低于非幸存者。多因素分析显示，ROSC 后 24 小时的 Pa-ETCO 差值与院内死亡率相关[比值比（95%置信区间）：1.30（1.07-1.59），p=0.0101]。在 ROC 曲线分析中，ROSC 后 24 小时 Pa-ETCO 差值的最佳截断值为 10.6mmHg（曲线下面积，0.843），敏感性为 77.8%，特异性为 85.7%。
ROSC 后 24 小时的 Pa-ETCO 差值与心脏骤停后患者的院内死亡率相关。
