Prehospital end-tidal carbon dioxide concentration and outcome in major trauma

Background. End-tidal carbon dioxide (Petco(2)) concentration is a marker of the pathophysiologic state because it is a reflection of cardiac output. Petco(2) correlates with outcome after prehospital primary cardiac arrest, but association with outcome from prehospital trauma has not been established. Method: Between 1998 and 2001, Petco(2) was recorded in 191 blunt trauma patients requiring prehospital intubation. Rapid sequence intubation was performed using suxamethonium (I mg/kg) and etomidate (0.2-0.3 mg/kg). Initial Petco(2), after endotracheal intubation (to) and Petco(2), at 20 minutes after endotracheal intubation (to) were recorded, together with survival to discharge. Results. Median Petco(2) at t(20) was 4.10 kPa in survivors and 3.50 kPa in non-survivors (95% confidence interval of difference between medians, 0.40 to 0.90 kPa; p < 0.0001). Petco(2) at t(20) was a better predictor of outcome than at to. Conclusion:Only 5% patients with Petco(2) < 3.25 kPa survived to discharge. Petco(2) at t(20) is of value in predicting outcome from major trauma.