Can Prehospital End Tidal Carbon Dioxide Values Predict Mortality In Trauma Patients
*Alexander J Kinstedt, *Jamie W Williams, Jonathan M Saxe, *Lewis E Jacobson, *Melissa A Smith, *Kelly J Blanton
Ascension St. Vincent Hospital, Indianapolis, IN
Objective(s): Prognosis of significantly injured patients during transport is difficult to determine. EtCO2 has been suggested to be a good predictor of mortality. The purpose of this study is to understand the prognostic value of EtCO2 in the injured patients in the Emergency Department.
Methods: We reviewed all patients transported to an urban level 1 trauma center with a record of prehospital EtCO2 between January 2018 and December 2018. Data collected included respiratory rate (RR), systolic and diastolic blood pressures (BP), heart rate (HR), oxygen saturation (SPO2), and end tidal carbon dioxide (EtCO2). The primary endpoint was mortality of the patient. Statistical analyses included Chi-squared tests and simple logistic regression.
Results: 277 patients were included in this study. The mean age was 49.9 years (22.8SD) (range 15-101yrs.) with 62.1% being male. 13% of the patients were discharged home from the ER, while 87% were admitted inpatient; 29% to the ICU (n=78) and 17% to the operating room (n=48), and 29 (10%) died. Of the patients 181 (65%) had EtCO2 values that were outside of the normal range (below 35 mmHg). The mean EtCO2 of non-survivors is 24.7 mmHg, while the mean for survivors is 32 mmHg. Chi-square statistical analysis comparing EtCO2 and mortality, resulted in a direct dependance (p=0.0488). Additionally, simple logistic regression analysis revealed a 6% increase in mortality (p=0.0068) as the EtCO2 dropped below normal.
Conclusion: There is a significant relationship between EtCO2 and mortality. EtCO2 should be routinely utilized in the Emergency Department to help determine the prognosis of severely injured patients.
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