Related Experiment Video
Updated: Mar 20, 2026
Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
Is End-Tidal Carbon Dioxide Indicative of Chest Compression Quality in Pediatric Out-of-Hospital Cardiac Arrest? A
Archit Sahai1, James Gray1,2, Yin Zhang3
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
End-tidal carbon dioxide (ETCO2) showed minimal association with chest compression (CC) rate but not depth or fraction in pediatric out-of-hospital cardiac arrest (OHCA). This suggests ETCO2 may have limited utility in assessing CC quality during pediatric OHCA resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Research
- Critical Care
Background:
- High-quality chest compressions (CC) are vital for pediatric out-of-hospital cardiac arrest (OHCA) survival.
- End-tidal carbon dioxide (ETCO2) is a potential non-invasive marker for assessing resuscitation quality.
Purpose of the Study:
- To investigate the association between ETCO2 levels and the quality of CC in pediatric patients experiencing OHCA.
- To determine if ETCO2 can serve as a reliable indicator of CC quality (rate, depth, fraction) in this population.
Main Methods:
- Retrospective observational study analyzing video recordings and defibrillator data from pediatric OHCA patients.
- Collected ETCO2 values and CC data, evaluating CC quality against American Heart Association (AHA) guidelines.
- Analyzed 380 one-minute epochs from 30 pediatric patients using linear mixed models.
Main Results:
- No significant association was found between ETCO2 and overall CC quality categories (low, marginal, adequate, optimal).
- A weak positive correlation was observed between ETCO2 and CC rate (r=0.113).
- No significant correlation was found between ETCO2 and CC depth (r=-0.102) or CC fraction (r=0.055).
Conclusions:
- ETCO2 demonstrated minimal association with CC rate and no significant association with CC depth or CC fraction in pediatric OHCA.
- The findings suggest ETCO2 may have limited utility in evaluating CC quality during pediatric OHCA.
- Study limitations include a small sample size, single center, lack of optimal CC quality, and unknown downtime.
Objectives:
To determine if end-tidal carbon dioxide (ETCO2) is associated with chest compression (CC) quality in pediatric patients presenting with out-of-hospital cardiac arrest (OHCA).
Methods:
We conducted a retrospective, observational, video review-based study in a pediatric emergency department. Children <18 years with OHCA from March 2021 to August 2022 were included. We collected ETCO2 values every 5 seconds via video review and CC data from an audiovisual defibrillator (Zoll R Series). CC data were evaluated in 1-minute epochs for compliance with American Heart Association (AHA) high-quality compression metrics for rate, depth, and CC fraction and categorized as low, marginal, adequate, or optimal. ETCO2 was averaged over each minute, aligned with CC epochs, and analyzed using a linear mixed model.
Results:
Fifty patients presented with OHCA, and 30 were included yielding 380 total epochs. Compression quality was low in 35 epochs, marginal in 196 epochs, adequate in 139 epochs, and optimal in 10 epochs. There was no significant association between ETCO2 and CC quality when comparing epoch categories. ETCO2 had a weak positive correlation with target compression rate (r = 0.113, 95% CI [0.011, 0.213]) but no significant correlation with target depth (r = -0.102, 95% CI [-0.202, 0.000]) or chest compression fraction (CCF) (r = 0.055, 95% [-0.046, 0.155]).
Conclusion:
In our small, single-center study, we found ETCO2 was minimally associated with compression rate but not depth or CCF and overall may be of limited utility in evaluating CC quality in pediatric OHCA. Our study was limited by the lack of optimal CC quality and unknown downtime.
More Related Videos
Related Concept Videos
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:21Cardiopulmonary Resuscitation I: Adult
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:30Acute Respiratory Failure-III
01:23Acute Respiratory Failure-IV
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...