Temporal Trends in End-Tidal Capnography and Outcomes in Out-of-Hospital Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial

Nassal, MMJ; Elola, A; Aramendi, E; Jaureguibeitia, X; Powell, JR; Idris, A; Raya Krishnamoorthy, BP; Daya, MR; Aufderheide, TP; Carlson, JN; Stephens, SW; Panchal, AR; Wang, HE

doi:10.1001/jamanetworkopen.2024.19274

Temporal Trends in End-Tidal Capnography and Outcomes in Out-of-Hospital Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial

JAMA Netw OpenPublished 1 Jul 2024Secondary analysis of the Pragmatic Airway Resuscitation Trial (PART) cluster randomised trial

Primary result · Association of temporal EtCO2 change (slope) with ROSCResultAOR for ROSC 1.45 95% CI 1.31–1.61

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Authors' conclusion

In this secondary analysis of the PART trial, temporal increases in EtCO2 were associated with increased odds of ROSC.

Study context

Population: Adults (≥18 years) with nontraumatic out-of-hospital cardiac arrest (OHCA) and advanced airway with >50% interpretable EtCO2 signal, Resuscitation Outcomes Consortium EMS agencies, 2015–2017EtCO2 available in 1172
Participants: 1,113 adults

Comparison: Return of spontaneous circulation (ROSC) vs non-ROSC cases
ROSCn = 198
non-ROSCn = 915reference
Primary endpoint: ROSC determined by prehospital or ED palpable pulses

Methodological detailscluster randomized, multicenter EMS agencies

Cluster randomized
Multicenter EMS agencies

Primary result

As reported in the abstract

Association of temporal EtCO2 change (slope) with ROSC

AOR for ROSC

1.45

95% CI 1.31–1.61

Events by treatment group

ROSC17.8%198

Non-ROSC82.2%915

ROSC vs non-ROSC cases (EtCO2 trends)

aOR for ROSC 1.45 (95% CI 1.31–1.61)

Further findings

Median EtCO2 10 min prior to end of resuscitation · 10 minutes prior to end of resuscitation · Mann-Whitney test

P < 0.001

ROSCmedian 39.8 mm HgIQR 27.1–56.4

non-ROSCmedian 26.1 mm HgIQR 14.9–39.0

Median EtCO2 5 min prior to end of resuscitation · 5 minutes prior to end of resuscitation · Mann-Whitney test

P < 0.001

ROSCmedian 43.0 mm HgIQR 28.1–55.8

non-ROSCmedian 25.0 mm HgIQR 13.3–37.4

EtCO2 temporal trend in ROSC cases

Median EtCO2 increased from 30.5 (IQR, 22.4-54.2) to 43.0 (IQR, 28.1-55.8) mm Hg: P for trend < 0.001

EtCO2 temporal trend in non-ROSC cases

EtCO2 declined from 30.8 (IQR, 18.2-43.8) to 22.5 (IQR, 12.8-35.4) mm Hg: P for trend < 0.001

Original publication

Temporal Trends in End-Tidal Capnography and Outcomes in Out-of-Hospital Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. Published 1 July 2024. doi:10.1001/jamanetworkopen.2024.19274

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