Diagnostic Accuracy of the Carbon Dioxide Gap (ΔCO2) in Predicting the Return of Spontaneous Circulation: A Prospective Single Center Study

Authors : Mehmet Muzaffer İSLAM, Gökhan AKSEL, Serkan Emre EROĞLU, Hayrullah YÖNAK

Pages : 211-218

Doi:10.29058/mjwbs.1233918

View : 22 | Download : 44

Publication Date : 2023-08-31

Article Type : Research Paper

Abstract :Aim: The carbon dioxide gap or ΔCO2 is the difference between the partial pressure of carbon dioxide insert ignore into journalissuearticles values(pCO2 ); and end-tidal carbon dioxide insert ignore into journalissuearticles values(ETCO2 );, which should normally not exceed 3-5mmHg. In critically ill patients ΔCO2 increases as a result of decreased cardiac output and pulmonary blood flow compromise. The primary outcome of this study is to examine the diagnostic accuracy of ΔCO2 in predicting the return of spontaneous circulation insert ignore into journalissuearticles values(ROSC); in out-of-hospital cardiac arrest insert ignore into journalissuearticles values(OHCA); patients. Material and Methods: Non-traumatic OHCA patients over 18 years of age were included in this prospective observational study. ETCO2 values were recorded 1 minute after the intubation and arterial blood gas samples were acquired simutaneously. The difference between the initial ΔCO2 medians of the ROSC+ and ROSC- patient groups were analyzed and the diagnostic test performance in predicting ROSC of ΔCO2 was calculated. A regression model was performed to accurately predict ROSC in OHCA patients. Results: A total of 46 patients were included to the inal analysis. The ΔCO2 median of the ROSC+ group was significantly lower than the ROSC- group insert ignore into journalissuearticles values(p=0.026, 95%CI:-31 to-3);. Area under the curve was calculated as 0.694 insert ignore into journalissuearticles values(95%CI: 0.532 to 0.855);, sensitivity 76.19% insert ignore into journalissuearticles values(95%CI:52.83 to 91.78%);, specificity 76% insert ignore into journalissuearticles values(95%CI:54.87 to 90.64);, and accuracy 76.09% insert ignore into journalissuearticles values(95%CI:61.23% to87.41%); for the optimal cut-off value insert ignore into journalissuearticles values(51.4 mmHg);. The regression model consists of age, initial ETCO2 , and initial cardiac rhythm showed good discrimination in predicting ROSC insert ignore into journalissuearticles values(AUC=0.846, 95%CI=0.735 to 0.956, p<0.001);. Conclusion: A statistically significant difference was found between the initial ΔCO2 medians in ROSC+ and ROSC- OHCA patients. However, the performance of this test indicates that ΔCO2 cannot be used as a stand-alone test to predict ROSC.
Keywords : ΔCO2, delta karbondioksit, karbondioksit gap, kardiyopulmoner resüsitasyon, spontan dolaşımın geri dönüşü, hastane dışı kardiyak arrest