AI Article Synopsis
- This study investigates the effectiveness of measuring end tidal carbon dioxide (ETCO) in predicting mortality among trauma patients before they reach the hospital, using a nasal capnography cannula (NCC) or in-line ventilator circuit (ILVC).
- Researchers collected ETCO data alongside other indicators like systolic blood pressure (SBP) and shock index (SI) from 550 trauma patients, finding that lower ETCO values were a better predictor of mortality compared to SBP and SI.
- The results suggest that prehospital ETCO measurements can significantly aid in assessing the risk of mortality for injured patients, indicating their potential use in emergency medical settings.
Article Abstract
Background: Prehospital identification of shock in trauma patients lacks accurate markers. Low end tidal carbon dioxide (ETCO) correlates with mortality in intubated patients. The predictive value of ETCO obtained by nasal capnography cannula (NCC) is unknown. We hypothesized that prehospital ETCO values obtained by NCC and in-line ventilator circuit (ILVC) would be predictive of mortality.
Methods: This was a prospective, observational, multicenter study. ETCO values were collected by a NCC or through ILVC. AUROCs were compared with prehospital systolic blood pressure (SBP) and shock index (SI). The Youden index defined optimal cutoffs.
Results: Of 550 enrolled patients, 487 (88.5%) had ETCO measured through an NCC. Median age was 37 (27-52) years; 76.5% were male; median ISS was 13 (5-22). Mortality was 10.4%. Minimum prehospital ETCO significantly predicted mortality with an AUROC of 0.76 (CI 0.69-0.84; Youden index = 22 mmHg), outperforming SBP with an AUROC of 0.68; (CI 0.62-0.74, p = 0.04) and shock index with an AUROC of 0.67 (CI 0.59-0.74, p = 0.03).
Conclusion: Prehospital ETCO measured by non-invasive NCC or ILVC may be predictive of mortality in injured patients.
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| http://dx.doi.org/10.1016/j.amjsurg.2023.07.033 | DOI Listing |
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