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Does EtCO2 Matter In Pediatric Arrest?

January 23, 2019

Written by Clay Smith

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There was no difference in survival to discharge in children with an EtCO2 >20mm Hg during CPR. Focus on high quality CPR and not this number.

Why does this matter?
The AHA recommends a goal EtCO2 of >20mm Hg as a gauge of CPR quality in children. But does this make a difference in outcome?

Nice target – that may not matter
This was a retrospective study of multiple PICUs that included children with arrest, CPR ≥1 minute, and EtCO2 tracings. They included 43 children. There was no difference in survival for children with EtCO2 >20 during CPR, RR 0.92 (95%CI 0.41 to 2.08). EtCO2 median was 20mm in survivors to discharge vs. 23mm in those who did not, meaning there was no association between median EtCO2 during arrest and survival. There was no dose-response; as EtCO2 rose higher than 20 (i.e. 25, 30, >30) there was no association with better survival. Likely more important was the cause of arrest to begin with and associated comorbidities. The study was limited by its small size and inclusion of only tertiary care academic ICU settings, which impacts generalizability. For me, I plan to focus less on the EtCO2 number and more on ensuring high quality CPR.

End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation. Resuscitation. 2018 Dec;133:173-179. doi: 10.1016/j.resuscitation.2018.08.013. Epub 2018 Aug 15.

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What are your thoughts?