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

doi:10.5847/wjem.j.1920-8642.2023.186

Abstract

Abstract:

BACKGROUND: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. This study examined whether end-tidal carbon dioxide (ETCO₂) and pulse oximetry photoplethysmogram (POP) parameters can be used to identify unsustained ROSC.
METHODS: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014. Patients’ general information, ETCO₂, and POP parameters were collected and statistically analyzed.
RESULTS: 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%, P<0.05). The logistic regression analysis showed that the difference between after and before ROSC in ETCO₂ (ΔETCO₂) and the difference between after and before ROCS in area under the curve of POP (ΔAUCp) were independently associated with sustained ROSC (odds ratio [OR]=0.931, 95% confidence interval [95% CI] 0.881-0.984, P=0.011 and OR=0.998, 95% CI 0.997-0.999, P<0.001). The area under the receiver operating characteristic curve of ΔETCO₂, ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962), respectively.
CONCLUSION: Patients with unsustained ROSC have a poor prognosis. The combination of ΔETCO₂ and ΔAUCp showed significant predictive value for unsustained ROSC.

Key words: Return of spontaneous circulation, Pulse oximetry photoplethysmogram, End-tidal carbon dioxide, Cardiac arrest, Cardiopulmonary resuscitation

Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph Harold Walline, Huadong Zhu, Yuguo Chen, Xuezhong Yu, Jun Xu. 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[J]. World Journal of Emergency Medicine, 2024, 15(1): 16-22.

Figures/Tables 3

Figure 1.

Table 1.

Figure 2.

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Parameters	Unsustained ROSC patients (n=32)	Sustained ROSC patients (n=48)	P-value
Sex, female, n (%)	7 (21.9)	17 (35.4)	0.195
Age, years, median (IQR)	63.0 (45.5, 77.0)	63.5 (50.3, 73.5)	0.848
Location of cardiac arrest, n (%)
Out of hospital	6 (18.8)	11 (22.9)	0.655
In hospital	26 (81.2)	37 (77.1)	0.655
Cause of cardiac arrest, n (%)
Cardiogenic	12 (37.5)	17 (35.4)	0.849
Hypoxemic	9 (28.1)	18 (37.5)	0.385
Shock	6 (18.8)	6 (12.5)	0.655
Stroke	2 (6.3)	3 (6.3)	1.000
Trauma	3 (9.4)	4 (8.3)	1.000
Survival rate, n (%)
24-hour survival	3 (9.4)	14 (29.2)	0.034^*
28-day survival	0 (0)	4 (8.3)	0.249

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