Abhiraj R, Ekka Meera, Sreekumar Aravind, Aggarwal Praveen, Jamshed Nayer, Bhoi Sanjeev Kumar, Khan Maroof Ahmed
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Turk J Emerg Med. 2025 Jul 1;25(3):199-207. doi: 10.4103/tjem.tjem_223_24. eCollection 2025 Jul-Sep.
We aimed to identify the ability of end-tidal carbon dioxide (EtCO2) to predict inhospital mortality of patients presenting to the emergency department (ED) with nontraumatic circulatory shock. We also attempted to assess the correlation between EtCO2 and other traditional vital signs and laboratory parameters in this patient population at different time points during their resuscitation.
This was a single-center prospective observational study conducted among patients with nontraumatic circulatory shock who presented to the ED of a tertiary care teaching institute in India. EtCO2 measurement was done using mainstream capnography in both intubated and nonintubated patients at presentation and at 120 min of resuscitation. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), respiratory rate, oxygen saturation, and laboratory parameters (lactate, base deficit [BD], and partial pressure of carbon dioxide) were measured at the same time points. All patients were followed up till hospital discharge.
One hundred and ten patients were recruited to the study. An EtCO2 of ≤ 23 mm Hg at presentation was 87% sensitive (95% CI: 73-95 %) and 43% specific (95% CI: 31-56 %) in predicting in-hospital mortality of patients presenting with no-traumatic circulatory shock in emergency department [area under curve (AUC): 0.735 (95% CI: 0.638-0.832, p<0.001)]. EtCO2 ≥23 mmHg at presentation had a significant predictive value on the risk of in-hospital mortality with an adjusted odd's ratio of 0.08 (95% CI: 0.02-0.3, < 0.001). EtCO2 values at presentation and 120 min as well as the change between the time points showed statistically significant weak-to-moderate positive correlations with corresponding values of MAP and BD. Similarly, a significant negative correlation was demonstrated with lactate levels at the same time points.
EtCO2 values at presentation are an independent predictor of inhospital mortality of patients with circulatory shock of nontraumatic etiology presenting to the ED.
我们旨在确定呼气末二氧化碳（EtCO2）预测急诊科（ED）非创伤性循环休克患者院内死亡率的能力。我们还试图评估该患者群体在复苏过程中不同时间点EtCO2与其他传统生命体征及实验室参数之间的相关性。
这是一项在印度一家三级护理教学机构的急诊科对非创伤性循环休克患者进行的单中心前瞻性观察研究。在患者就诊时及复苏120分钟时，对插管和未插管患者均使用主流二氧化碳监测仪测量EtCO2。在相同时间点测量心率、收缩压、舒张压、平均动脉压（MAP）、呼吸频率、血氧饱和度及实验室参数（乳酸、碱缺失[BD]和二氧化碳分压）。所有患者随访至出院。
110名患者纳入研究。就诊时EtCO2≤23 mmHg预测急诊科非创伤性循环休克患者院内死亡率的敏感度为87%（95%CI：73 - 95%），特异度为43%（95%CI：31 - 56%）[曲线下面积（AUC）：0.735（95%CI：0.638 - 0.832，p<0.001）]。就诊时EtCO2≥23 mmHg对院内死亡风险具有显著预测价值，校正比值比为0.08（95%CI：0.02 - 0.3，p<0.001）。就诊时及120分钟时的EtCO2值以及时间点之间的变化与MAP和BD的相应值呈统计学显著的弱至中度正相关。同样，在相同时间点与乳酸水平呈显著负相关。
就诊时的EtCO2值是急诊科非创伤性病因循环休克患者院内死亡率的独立预测指标。
