Frequency of Return of Spontaneous Circulation After Effective Cardiopulmonary Resuscitation Monitored by End Tidal Carbon Dioxide
Spontaneous Circulation After Effective CPR Monitored by End Tidal Carbon Dioxide
DOI:
https://doi.org/10.54393/pjhs.v7i9.4067Keywords:
Cardiac Arrest, Cardiopulmonary Resuscitation, Return of Spontaneous Circulation, End-Tidal Carbon DioxideAbstract
Cardiac arrest is a critical emergency with high mortality despite advances in resuscitation. Objectives: To determine the frequency of ROSC after effective CPR and to evaluate the role of ETCO2 monitoring as a predictor of resuscitation outcomes. Methods: This analytical cross-sectional study was conducted in the Department of Emergency Medicine, Central Park Teaching Hospital, Lahore, from May 2024 to September 2024. A total of 127 patients aged 40-70 years who experienced cardiopulmonary arrest were enrolled using non-probability consecutive sampling. CPR was performed with continuous capnography monitoring. Results: The mean age of patients was 56.8 ± 8.5 years; 64.6% were male. The most common cause of arrest was acute myocardial infarction (48.0%), followed by arrhythmias (22.0%), sepsis (16.5%), and respiratory failure (13.5%). ROSC was achieved in 45 patients (35.4%). Patients with ROSC had significantly shorter CPR duration (15.2 ± 5.3minutes vs. 20.6 ± 7 minutes; p<0.001. AnETO2 ≥ 10mmHg after 20 minutes and an abrupt rise in ETCO2 were strongly associated with ROSC (p<0.001). No significant association was found with gender (p=0.610). Myocardial infarction as the cause of arrest was significantly linked with higher ROSC compared to non-cardiac causes (p=0.004). Conclusions: The frequency of ROSC after CPR was 35.4%. ETCO2 monitoring was found to be a reliable predictor of resuscitation success, with higher values and abrupt rises strongly associated with ROSC. Shorter CPR duration and cardiac causes of arrest were favorable prognostic factors.
References
Sakaguchi K, Saito S, Takada M, Takahashi K, Onodera Y, Kobayashi T et al. Correlation Between Pulse-Wave Cerebral Tissue Oxygen Saturation and End-Tidal Carbon Dioxide During Cardiopulmonary Resuscitation. The American Journal of Emergency Medicine. 2025 Oct; 96: 134-9. doi: 10.1016/j.ajem.2025.06.051. DOI: https://doi.org/10.1016/j.ajem.2025.06.051
Wu CY, Lu TC, Su PI, Tsai CL, Tay J, Wu MC et al. End-Tidal Carbon Dioxide + Return of Spontaneous Circulation After Cardiac Arrest (RACA) Score to Predict Outcomes After Out-of-Hospital Cardiac Arrest. Western Journal of Emergency Medicine. 2023 Apr; 24(3): 605. doi: 10.5811/WESTJEM.59005. DOI: https://doi.org/10.5811/WESTJEM.59005
Kornfehl A, Brock R, Veigl C, Firich V, Gatterbauer M, Girsa M et al. Cerebral Oxygen Saturation in Relation to End-Tidal CO2 in Cardiopulmonary Resuscitation–Separate Views of Brain and Body? Resuscitation Plus. 2025 Jul: 101044. doi: 10.1016/j.resplu.2025.101044. DOI: https://doi.org/10.1016/j.resplu.2025.101044
Wu L, Narasimhan B, Bhatia K, Ho KS, Krittanawong C, Aronow WS et al. Temporal Trends in Characteristics and Outcomes Associated with in‐Hospital Cardiac Arrest: A 20‐Year Analysis (1999–2018). Journal of the American Heart Association. 2021 Dec; 10(23): e021572. doi: 10.1161/JAHA.121.021572. DOI: https://doi.org/10.1161/JAHA.121.021572
Gräsner JT, Herlitz J, Tjelmeland IB, Wnent J, Masterson S, Lilja G et al. European Resuscitation Council Guidelines 2021: epidemiology of cardiac arrest in Europe. Resuscitation. 2021 Apr; 161: 61-79. doi: 10.1016/j.resuscitation.2021.02.007. DOI: https://doi.org/10.1016/j.resuscitation.2021.02.007
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics—2019 Update: A Report from the American Heart Association. Circulation. 2019 Mar; 139(10): e56-28.
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T et al. European Resuscitation Council Guidelines 2021: Adult Advanced Life Support. Resuscitation. 2021 Apr; 161: 115-51. doi: 10.1016/j.resuscitation.2021.02.010. DOI: https://doi.org/10.1016/j.resuscitation.2021.02.010
Skulec R, Vojtisek P, Cerny V. Correlation Between End-Tidal Carbon Dioxide and the Degree of Compression of Heart Cavities Measured by Transthoracic Echocardiography During Cardiopulmonary Resuscitation for Out-Of-Hospital Cardiac Arrest. Critical Care. 2019 Oct; 23(1): 334. doi: 10.1186/s13054-019-2607-2. DOI: https://doi.org/10.1186/s13054-019-2607-2
Perkins GD and Nolan J. European Resuscitation Council Guidelines for Resuscitation 2021. Resuscitation. 2021; 161: 1-432. doi: 10.1016/j.resuscitation.2021.02.003. DOI: https://doi.org/10.1016/j.resuscitation.2021.02.009
Takegawa R, Hayashida K, Rolston DM, Li T, Miyara SJ, Ohnishi M et al. Near-Infrared Spectroscopy Assessments of Regional Cerebral Oxygen Saturation for the Prediction of Clinical Outcomes in Patients with Cardiac Arrest: A Review of Clinical Impact, Evolution, and Future Directions. Frontiers in Medicine. 2020 Oct; 7: 587930. doi: 10.3389/fmed.2020.587930. DOI: https://doi.org/10.3389/fmed.2020.587930
Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for in-Hospital Cardiac Arrest: A Consensus Report from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Circulation. 2019 Oct; 140(18): e746-57. doi: 10.1161/CIR.0000000000000710. DOI: https://doi.org/10.1161/CIR.0000000000000710
Lim SL, Myint MZ, Woo KL, Chee EY, Hong CS, Beqiri E et al. Multi-Modal Assessment of Cerebral Hemodynamics in Resuscitated Out-of-Hospital Cardiac Arrest Patients: A Case-Series. Life. 2024 Aug; 14(9): 1067. doi: 10.3390/life14091067. DOI: https://doi.org/10.3390/life14091067
Putowski M, Dudzikowska M, Wieczorek W, Pruc M, Szarpak L, Siudak Z. Correlation Between End-Tidal Carbon Dioxide and Regional Cerebral Oxygen Saturation During Cardiopulmonary Resuscitation. Journal of Clinical Medicine. 2025 May; 14(11): 3747. doi: 10.3390/jcm14113747. DOI: https://doi.org/10.3390/jcm14113747
Morin CM, Cheung PY, Lee TF, O’Reilly M, Schmölzer GM. Chest Compressions Superimposed with Sustained Inflations During Cardiopulmonary Resuscitation in Asphyxiated Pediatric Piglets. Pediatric Research. 2024 Mar; 95(4): 988-95. doi: 10.1038/s41390-023-02563-9. DOI: https://doi.org/10.1038/s41390-023-02563-9
Rawat M, Mani S, Gugino SF, Koenigsknecht C, Helman J, Nielsen L et al. Femoral Occlusion during Neonatal Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of Perinatal Cardiac Arrest. Children. 2023 Nov; 10(11): 1804. doi: 10.3390/children10111804. DOI: https://doi.org/10.3390/children10111804
Gutiérrez JJ, Leturiondo M, Ruiz de Gauna S, Ruiz JM, Azcarate I, González-Otero DM et al. Assessment of the Evolution of End-Tidal Carbon Dioxide within Chest Compression Pauses to Detect Restoration of Spontaneous Circulation. PLoS One. 2021 May; 16(5): e0251511. doi: 10.1371/journal.pone.0251511. DOI: https://doi.org/10.1371/journal.pone.0251511
Engel II TW, Thomas C, Medado P, Bastani A, Reed B, Millis S et al. End Tidal CO2 and Cerebral Oximetry for the Prediction of Return of Spontaneous Circulation During Cardiopulmonary Resuscitation. Resuscitation. 2019 Jun; 139: 174-81. doi: 10.1016/j.resuscitation.2019.04.006. DOI: https://doi.org/10.1016/j.resuscitation.2019.04.006
Morgan RW, Reeder RW, Bender D, Cooper KK, Friess SH, Graham K et al. Associations Between End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality, and Survival. Circulation. 2024 Jan; 149(5): 367-78.
Compagnoni S, Gentile FR, Baldi E, Contri E, Palo A, Primi R et al. Peripheral Perfusion Index and Diagnostic Accuracy of the Post-ROSC Electrocardiogram in Patients with Medical Out-Of-Hospital Cardiac Arrest. Resuscitation. 2021 Nov; 168: 19-26. doi: 10.1016/j.resuscitation.2021.08.050. DOI: https://doi.org/10.1016/j.resuscitation.2021.08.050
Chu CH, Shih HM, Yu SH, Chang SS, Sie JS, Huang FW et al. Risk Factors for Sudden Cardiac Arrest in Patients With ST-Segment Elevation Myocardial Infarction: A Retrospective Cohort Study. BioMed Central Emergency Medicine. 2022 Oct; 22(1): 169. doi: 10.1186/s12873-022-00732-3. DOI: https://doi.org/10.1186/s12873-022-00732-3
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