A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

• Published in: World journal of emergency medicine Vol. 15; no. 1; pp. 16 - 22
• Main Authors: Yang, Jing, Tang, Hanqi, Shao, Shihuan, Xu, Feng, Fu, Yangyang, Xu, Shengyong, Li, Chen, Li, Yan, Liu, Yang, Harold Walline, Joseph, Zhu, Huadong, Chen, Yuguo, Yu, Xuezhong, Xu, Jun
• Format: Journal Article
• Language: English
• Published: China World Journal of Emergency Medicine 01.01.2024; Emergency Department,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China%Emergency Department,Peking University People's Hospital,Beijing 100044,China%Department of Emergency and Chest Pain Center; Key Laboratory of Emergency and Critical Care Medicine of Shandong Province,Qilu Hospital of Shandong University,Jinan 250012,China%Emergency Department,Beijing Jishuitan Hospital,Beijing 100035,China%Emergency Department,Tianjin Medical University General Hospital,Tianjin 300052,China%Department of Emergency Medicine,Penn State Health Milton S.Hershey Medical Center and Penn State College of Medicine,Hershey 17033,USA; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Second Affiliated Hospital of Zhejiang University School of Medicine
• Subjects: Analysis; Cardiac arrest; Cardiac patients; Medical research; Medicine, Experimental; Original; Oximetry; Patient monitoring equipment; China; End-tidal carbon dioxide; Return of spontaneous circulation; Cardiopulmonary resuscitation; Pulse oximetry photoplethysmogram; Cardiac arrest
• DOI: 10.5847/wjem.j.1920-8642.2023.186
• ISSN: 1920-8642

Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. This study examined whether end-tidal carbon dioxide (ETCO ) and pulse oximetry photoplethysmogram (POP) parameters can be used to identify unsustained ROSC. We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014. Patients' general information, ETCO , and POP parameters were collected and statistically analyzed. The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group (29.2% vs. 9.4%, <0.05). The logistic regression analysis showed that the difference between after and before ROSC in ETCO (ΔETCO ) and the difference between after and before ROCS in area under the curve of POP (ΔAUCp) were independently associated with sustained ROSC (odds ratio [ ]=0.931, 95% confidence interval [95% ] 0.881-0.984, =0.011 and =0.998, 95% 0.997-0.999, <0.001). The area under the receiver operating characteristic curve of ΔETCO , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% 0.660-0.844), 0.883 (95% 0.818-0.948), and 0.902 (95% 0.842-0.962), respectively. Patients with unsustained ROSC have a poor prognosis. The combination of ΔETCO and ΔAUCp showed significant predictive value for unsustained ROSC.