Predictive Value of End-tidal Carbon Dioxide for Return of Spontaneous Circulation, Survival, and Neurological...

To analyze the factors influencing the return of spontaneous circulation (ROSC) in adult patients with cardiac arrest (CA) in the emergency department and to explore the value of end-tidal carbon dioxide (PETCO₂) in predicting cardiopulmonary resuscitation (CPR) outcomes.

A prospective study was conducted, enrolling 133 adult patients who experienced cardiac arrest and underwent CPR from January 2023 to January 2024. Based on outcome indicators, patients were categorized into the ROSC group (n = 69) and the non-ROSC group (n = 64). The differences in demographic characteristics, resuscitation measures, and PETCO₂ levels at different time points between the 2 groups were compared. Additionally, the 72-hour survival status and brain function prognosis of ROSC group patients were evaluated to analyze the relationship between PETCO₂ levels and patient outcomes.

Cardiac arrest etiology, defibrillation, CPR duration ≤30 minutes, lower doses of epinephrine, and lower doses of 5% sodium bicarbonate were significantly associated with ROSC occurrence (P < 0.01). PETCO₂ levels at 0-minute, 5-minute, 10-minute, 15-minute, and 20-minute time points, as well as initial, terminal, and average PETCO₂ levels, were significantly higher in the ROSC group compared to the non-ROSC group (P < 0.001). Furthermore, within the ROSC group, the survival group had significantly higher PETCO₂ levels at 10, 15, and 20 minutes than the nonsurvival group (P < 0.001). Similarly, the favorable brain function outcome group had significantly higher PETCO₂ levels at 10, 15, and 20 minutes than the poor brain function outcome group (P < 0.01).

PETCO₂ levels may be associated with the occurrence of ROSC, survival prognosis, and brain function outcomes in CA patients, suggesting a potential adjunctive role in resuscitation assessment. PETCO₂ monitoring during CPR-particularly sustained levels at 10 to 20 minutes-may serve as a valuable adjunctive tool for predicting ROSC, short-term survival, and neurological prognosis in adult CA patients. These findings support integrating real-time PETCO₂ trends into resuscitation protocols.