Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients

중증 외상 환자에서의 응급중재술 시행 예측 인자로서의 호기말 이산화탄소 분압의 유용성

  • Kim, Sung Ho (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Kim, Seunghwan (Center for Disaster Relief Training and Research, Yonsei University Severance Hospital) ;
  • Lee, Jae Gil (Department of Surgery, Yonsei University College of Medicine) ;
  • Chung, Sung Phil (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Kim, Seung Ho (Department of Emergency Medicine, Yonsei University College of Medicine)
  • 김성호 (연세대학교 의과대학 응급의학교실) ;
  • 김승환 (연세대학교 세브란스병원 재난의료교육센터) ;
  • 이재길 (연세대학교 의과대학 외과학교실) ;
  • 정성필 (연세대학교 의과대학 응급의학교실) ;
  • 김승호 (연세대학교 의과대학 응급의학교실)
  • Received : 2014.08.05
  • Accepted : 2014.10.14
  • Published : 2014.12.31
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Abstract

Purpose: If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide ($ETCO_2$) as a surrogate marker for predicting both the need for intervention and the prognosis. Methods: This is a prospective observational study. Nasal cannula was applied to measure $ETCO_2$, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients. Results: A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), $ETCO_2$ (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), $HCO_3$ (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only $ETCO_2$ (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, p-value= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas $ETCO_2$ (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)]. Conclusion: This study has revealed that $ETCO_2$, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.

Keywords

References

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