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Medline ® Abstract for Reference 55

of 'Carbon dioxide monitoring (capnography)'

Prehospital end-tidal carbon dioxide concentration and outcome in major trauma.
Deakin CD, Sado DM, Coats TJ, Davies G
J Trauma. 2004;57(1):65.
BACKGROUND: End-tidal carbon dioxide (Petco2) concentration is a marker of the pathophysiologic state because it is a reflection of cardiac output. Petco2 correlates with outcome after prehospital primary cardiac arrest, but association with outcome from prehospital trauma has not been established.
METHODS: Between 1998 and 2001, Petco2 was recorded in 191 blunt trauma patients requiring prehospital intubation. Rapid sequence intubation was performed using suxamethonium (1 mg/kg) and etomidate (0.2-0.3 mg/kg). Initial Petco2 after endotracheal intubation (t0) and Petco2 at 20 minutes after endotracheal intubation (t20) were recorded, together with survival to discharge.
RESULTS: Median Petco2 at t20 was 4.10 kPa in survivors and 3.50 kPa in nonsurvivors (95% confidence interval of difference between medians, 0.40 to 0.90 kPa; p<0.0001). Petco2 at t20 was a better predictor of outcome than at t0.
CONCLUSION: Only 5% patients with Petco2<3.25 kPa survived to discharge. Petco2 at t20 is of value in predicting outcome from major trauma.
Helicopter Emergency Service, Royal London Hospital, Whitechapel, London, United Kingdom. charlesdeakin@doctors.org.uk