Study on Changes of PETCO2 Before and After Cardiopulmonary Resuscitation and Its Relationship with Prognosis in Patients with Cardiac Arrest

WANG Xiaolei; WANG Qiuyan; YU Meijun; CHEN Jing; ZENG Jun; LI Liping; WU Shuang

doi:10.13730/j.issn.2097-2148.2025.09.006

Abstract：Objective To explore the changes of end-tidal carbon dioxide tension(PETCO2)level after cardiopulmonary re-suscitation and its relationship with prognosis in patients with cardiac arrest.Methods A retrospective analysis was performed on the clinical data of 107 patients with cardiac arrest in author's hospital from May 2018 to May 2023,PETCO2 was continuously monitored by electrocardiographic monitoring at different timing,according to the return of spontaneous circulation(ROSC),those who recovered from ROSC after cardiopulmonary resuscitation were included in the ROSC group(n=38)and those who did not were included in the non-ROSC group(n=69),according to the survival status of patients at 24 h after cardiopulmonary re-suscitation,the patients in the ROSC group were divided into survival group(n=22)and death group(n=16).The general data of patients in ROSC group and non-ROSC group were compared;Logistic regression was used to analyze the influencing factors of ROSC in patients with cardiac arrest and cardiopulmonary resuscitation;PETCO2 levels were compared between ROSC group and non-ROSC group at 0,5,10 and 20 min after resuscitation,receiver operating characteristic(ROC)curve was used to analyze the predictive value of PETCO2 level at each timing for the prognosis of patients;PETCO2 level at 6 h after resuscitation was compared between the survival group and the death group,the ROC curve was used to analyze the predictive val-ue of PETCO2 level at 6 h after resuscitation for the death of patients within 24 h.Results ① The proportions of patients with cardiogenic cardiac arrest and non-defibrillation heart rhythm in non-ROSC group were higher than those in ROSC group,while the proportion of PETCO2 level＞18 mmHg was lower than that in ROSC group(all P＜0.05).② The results of Logistic regression analysis showed that cardiogenic cardiac arrest,non-defibril-lation heart rhythm and low level of PETCO2 were independent risk factors of ROSC.③ In the non-ROSC group,the PETCO2 lev-el of patients was first increased and then decreased with the extension of resuscitation time,reached the peak at 5 min of resusci-tation,and then continued to decrease,and the differences at different timing were statistically significant(all P＜0.05);in ROSC group,the level of PETCO2 increased gradually with the extension of resuscitation time,and the differences at different timing were statistically significant(all P＜0.05);compared with the non-ROSC group,the PETCO2 level increased at each tim-ing in the ROSC group(all P＜0.05).④ The ROC area under the curve(AUC)of PETCO2levels at 0,5,10 and 20 min after resuscitation for predicting ROSC were 0.682,0.777,0.804 and 0.928,respectively.⑤ PETCO2 level at 6 h after resuscitation was higher in the survival group than in the death group(P＜0.05).AUC of PETCO2 level at 6 h after successful resuscitation in ROSC patients for predicting death within 24 h was 0.807(95％CI:0.658-0.956),the sensitivity was 81.25％and the spe-cificity was 86.36％.Conclusion Monitoring the change of PETCO2 in patients with cardiac arrest during cardiopulmonary resus-citation shows that PETCO2 is related to the prognosis of patients,PETCO2 can be used as an evaluation index for the effectiveness of resuscitation and early prognosis of resuscitation.