Patients with low ETCO2 are 5.10 times greater odds of mortality than those with normal/high ETCO2 (95% CI 1.05-24.90, p=0.044).Patients with low ETCO2 are 4.65 times more likely to needed blood transfusions, compared to 3.6% of the patients with normal/high ETCO2 (95% CI 2.01, 10.72 PPatients with low ETCO2 were likely to have higher trauma activation (27.4% vs 19.8%, p=0.048)īlood transfusion, mortality, and other clinical outcomes.Injury mechanism and vital signs were statistically similar between both groups (p >0.05) - This includes mostly vehicle collision, fall, assault, and penetrating trauma.Patients with lower ETCO2 were significantly older than those with normal/high ETCO2 (53 vs 45, p=0.011).Median ETCO2 in the low ETCO2 group is 22mmHg, and 35mmHg in the normal/high ETCO2.Median collection time of non-invasive side-stream ETCO2 was within 4 minutes of arrival.Any hospital complication (pneumonia, sepsis, wound infection, alcohol withdrawal, pulmonary embolism, deep vein thrombosis, respiratory failure).All-cause mortality (including deaths occurring in the trauma bay).Transfusion of blood products (>4 units) with 24 hrs of presentation.This comparison was made by calculated sensitivity, specificity, and area under the receiver operating curve (ROC) for ETCO2 and SI. Unadjusted and multivariable logistic and linear regression were used to estimate the association between ETCO2 and the primary and secondary outcomes.ĮTCO2 was also compared to the validated shock index (SI) to predict the need for blood transfusions (>4 units in the first 24 hours). Patient demographics and clinical characteristics were compared using Chi-square test for categorical data and Wilcoxon rank some tests for continuous variables. Patients were dichotomized into low (29.5 mmHg) ETCO2 groups by the Lui method of cut point estimation which maximizes specificity and sensitivity. This study was a single-center retrospective observational cohort study of 955 patients that analyzed the association between initial in-hospital ETCO2 of non-intubated trauma patients and transfusion requirements, as well as other clinical outcomes. Patients with erroneous ETCO2 (0- and 1mmHg) values.Patient intubated prior to ETCO2 measurement.Patient presenting as a trauma activation or having been entered into the trauma registry between 20.Patients with measured trauma bay ETCO2.Initial ETCO2 obtained from side-stream nasal canula capnography.

1,4Īs such, this article is of a single-center retrospective observational cohort study that aims to show that non-invasive (side-stream) ETCO2 monitoring in early trauma resuscitation can be useful in assessing occult shock

3-5įurthermore, prior studies focused on mainstream capnography in intubated patients, but a recent retrospective cohort study of non-intubated trauma patients who received pre-hospital side-stream capnography showed that low ETCO2 was associated with increased morbidity and mortality. 1,2 While commonly used to evaluate the quality of chest compressions and appropriate placement of advanced airway, ETCO2 has not been robustly studied in the triage setting. End tidal capnography (ETCO2) is commonly utilized by clinicians to access a critical patient’s hemodynamic and metabolic fluctuations, as rising lactate levels with tissue malperfusion are generally accompanied by a decrease in ETCO2. Objective: To evaluate the association between end-tidal capnography (ETCO2) in non-intubated trauma patients and blood product transfusion product requirements (primary outcome), other clinical outcomes, and to extrapolate the utility of ETCO2 in early trauma management.īackground: The triage and determination of patients in shock in the trauma setting continues to be difficult and has limited parameters. Low initial in-hospital end-tidal carbon dioxide predicts poor patient outcomes and is a useful trauma bay adjunct. Article: Portelli Tremont JN, Caldas RA, Cook N, Udekwu PO, Moore SM.

Normal end tidal co2 levels