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Mathematical Modeling for Prediction of Survival From Resuscitation Based on Computerized Continuous Capnography: Proof of Concept

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ACADEMIC EMERGENCY MEDICINE 2011; 18:468–475 © 2011 by the Society for Academic Emergency Medicine
Abstract

Objectives:  The objective was to describe a new method of studying correlations between real‐time end tidal carbon dioxide (ETCO2) data and resuscitation outcomes.

Methods:  This was a prospective cohort study of 30 patients who underwent cardiopulmonary resuscitation (CPR) in a university hospital. Sidestream capnograph data were collected during CPR and analyzed by a mathematician blinded to patient outcome. The primary outcome measure was to determine whether a meaningful relationship could be drawn between detailed computerized ETCO2 characteristics and the return of spontaneous circulation (ROSC). Significance testing was performed for proof‐of‐concept purposes only.

Results:  Median patient age was 74 years (interquartile range [IQR] = 60–80 years; range = 16–92 years). Events were mostly witnessed (63%), with a median call‐to‐arrival time of 150 seconds (IQR = 105–255 seconds; range = 60–300 seconds). The incidence of ROSC was 57% (17 of 30), and of hospital discharge 20% (six of 30). Ten minutes after intubation, patients with ROSC had higher peak ETCO2 values (p = 0.035), larger areas under the ETCO2 curve (p = 0.016), and rising ETCO2 slopes versus flat or falling slopes (p = 0.016) when compared to patients without ROSC. Cumulative maxETCO2 > 20 mm Hg at all time points measured between 5 and 10 minutes postintubation best predicted ROSC (sensitivity = 0.88; specificity = 0.77; p < 0.001). Mathematical modeling targeted toward avoiding misdiagnosis of patients with recovery potential (fixed condition, false‐negative rate = 0) demonstrated that cumulative maxETCO2 (at 5–10 minutes) > 25 mm Hg or a slope greater than 0 measured between 0 and 8 minutes correctly predicted patient outcome in 70% of cases within less than 10 minutes of intubation.

Conclusions:  This preliminary study suggests that computerized ETCO2 carries potential as a tool for early, real‐time decision‐making during some resuscitations.
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Document Type: Research Article

Affiliations: 1: From the Adult (SE) and Neonatal (RB) Critical Care Units, Shaare Zedek Medical Center, and the Department of Anesthesia (CFW), Hadassah-Hebrew University Medical Center, Jerusalem; and the Department of Anesthesia of the Sourasky Medical Center (IM), Tel-Aviv, Israel. 2: From the Adult (SE) and Neonatal (RB) Critical Care Units, Shaare Zedek Medical Center, and the Department of Anesthesia (CFW), Hadassah-Hebrew University Medical Center, Jerusalem; and the Department of Anesthesia of the Sourasky Medical Center (IM), Tel-Aviv, Israel.

Publication date: 01 May 2011

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