Journal article
Prehospital end-tidal carbon dioxide is predictive of death and massive transfusion in injured patients: An Eastern Association for Surgery of Trauma multicenter trial
The journal of trauma and acute care surgery, Vol.92(2), pp.355-361
01 Feb 2022
PMID: 34686640
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BACKGROUND Prehospital identification of the injured patient likely to require emergent care remains a challenge. End-tidal carbon dioxide (ETCO2) has been used in the prehospital setting to monitor respiratory physiology and confirmation of endotracheal tube placement. Low levels of ETCO2 have been demonstrated to correlate with injury severity and mortality in a number of in-hospital studies. We hypothesized that prehospital ETCO2 values would be predictive of mortality and need for massive transfusion (MT) in intubated patients. METHODS This was a retrospective multicenter trial with 24 participating centers. Prehospital, emergency department, and hospital values were collected. Receiver operating characteristic curves were created and compared. Massive transfusion defined as >10 U of blood in 6 hours or death in 6 hours with at least 1 U of blood transfused. RESULTS A total of 1,324 patients were enrolled. ETCO2 (area under the receiver operating characteristic curve [AUROC], 0.67; confidence interval [CI], 0.63-0.71) was better in predicting mortality than shock index (SI) (AUROC, 0.55; CI, 0.50-0.60) and systolic blood pressure (SBP) (AUROC, 0.58; CI, 0.53-0.62) (p < 0.0005). Prehospital lowest ETCO2 (AUROC, 0.69; CI, 0.64-0.75), SBP (AUROC, 0.75; CI, 0.70-0.81), and SI (AUROC, 0.74; CI, 0.68-0.79) were all predictive of MT. Analysis of patients with normotension demonstrated lowest prehospital ETCO2 (AUROC, 0.66; CI, 0.61-0.71), which was more predictive of mortality than SBP (AUROC, 0.52; CI, 0.47-0.58) or SI (AUROC, 0.56; CI, 0.50-0.62) (p < 0.001). Lowest prehospital ETCO2 (AUROC, 0.75; CI, 0.65-0.84), SBP (AUROC, 0.63; CI, 0.54-0.74), and SI (AUROC, 0.64; CI, 0.54-0.75) were predictive of MT in normotensive patients. ETCO2 cutoff for MT was 26 mm Hg. The positive predictive value was 16.1%, and negative predictive value was high at 98.1%. CONCLUSION Prehospital ETCO2 is predictive of mortality and MT. ETCO2 outperformed traditional measures such as SBP and SI in the prediction of mortality. ETCO2 may outperform traditional measures in predicting need for transfusion in occult shock.
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Details
- Title
- Prehospital end-tidal carbon dioxide is predictive of death and massive transfusion in injured patients: An Eastern Association for Surgery of Trauma multicenter trial
- Creators
- Eric M. Campion - San Francisco General HospitalAlexis Cralley - Denver Health Medical CenterAngela Sauaia - San Francisco General HospitalRon C. Buchheit - San Francisco General HospitalAustin T. Brown - University of Michigan–Ann ArborM. Chance Spalding - San Francisco General HospitalAimee LaRiccia - San Francisco General HospitalScott Moore - San Francisco General HospitalKimberly Tann - University of Colorado DenverJohn Leskovan - University of Colorado DenverMaraya Camazine - San Francisco General HospitalStephen L. Barnes - San Francisco General HospitalBanan Otaibi - San Francisco General HospitalJoshua P. Hazelton - San Francisco General HospitalLewis E. Jacobson - San Francisco General HospitalJamie Williams - San Francisco General HospitalRoberto Castillo - San Francisco General HospitalNakosi J. Stewart - San Francisco General HospitalJoel B. Elterman - San Francisco General HospitalLinda Zier - San Francisco General HospitalMichael Goodman - San Francisco General HospitalNora Elson - University of Michigan–Ann ArborJason Miner - San Francisco General HospitalClaire Hardman - University of Michigan–Ann ArborCarolijn Kapoen - San Francisco General HospitalApril E. Mendoza - San Francisco General HospitalMorgan Schellenberg - San Francisco General HospitalElizabeth Benjamin - University of Colorado DenverGlenn K. Wakam - San Francisco General HospitalHasan B. Alam - San Francisco General HospitalLucy Z. Kornblith - University of Michigan–Ann ArborRachael A. Callcut - San Francisco General HospitalLauren E. Coleman - University of Michigan–Ann ArborDavid Shatz - San Francisco General HospitalSigrid Burruss - San Francisco General HospitalAnn C. Linn - San Francisco General HospitalLindsey Perea - San Francisco General HospitalMadison Morgan - University of Colorado DenverThomas J. Schroeppel - San Francisco General HospitalZachery Stillman - San Francisco General HospitalMatthew M. Carrick - San Francisco General HospitalMario F. Gomez - San Francisco General HospitalJohn D. Berne - University of Colorado DenverRobert C. McIntyre - San Francisco General HospitalShane Urban - University of Colorado Anschutz Medical CampusJeffry Nahmias - San Francisco General HospitalErika Tay - University of Colorado DenverMitchell Cohen - San Francisco General HospitalErnest E. Moore - San Francisco General HospitalKevin McVaney - San Francisco General HospitalClay Cothren Burlew - San Francisco General Hospital
- Publication Details
- The journal of trauma and acute care surgery, Vol.92(2), pp.355-361
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000746928900018
- Scopus ID
- 2-s2.0-85124144568
- Other Identifier
- 991022057015604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Surgery