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Higher ETCO2 and Better Outcomes in Pediatric Arrest

April 18, 2024

Written by Denrick Cooper

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Targeted ETCO2 ≥20 mm Hg during pediatric resuscitation was associated with higher rate of survival in patients with in-hospital cardiac arrest.

I want to take you higher!
Multiple studies show that a target ETCO2 > 20 mm Hg during adult resuscitation is associated with ROSC and greater survival. Chest compression quality and overall resuscitation success can be tailored based on changes in ETCO2 dynamics. This study is the first to find an association between an ETCO2 target during cardiac resuscitation and survival in the pediatric population.

This multicenter prospective observational cohort study was conducted in ICU settings across 10 clinical sites. In total, 234 children were separated into 2 cohorts. One cohort with event-level average ETCO2 ≥20 mm Hg compared to subjects with ETCO2 <20 mm Hg. An average ETCO2 ≥20 mm Hg was associated with higher rates of sustained ROSC (71% vs 58%, RR 1.22) and survival to discharge (65% vs 48%, RR, 1.33) but not with survival with favorable neurological outcome or new morbidity. Higher ETCO2 was also associated with improved average SBP mm Hg (90.6 vs. 70.9) and average DBP (46.5 vs. 33.3). There was no statistically significant difference in CPR quality between cohorts based on average chest compression rate and depth, so it’s difficult to say where PICU teams can focus improvement efforts.

How will this change my practice?
This provides valuable evidence to support the use of ETCO2-guided resuscitation in pediatric patients. I plan to use an ETCO2 level of ≥20 mm HG as a resuscitation target, particularly in the early stages of treatment. If the target level is not achieved for an extended period, I will consider the possibility that resuscitation may not be successful.

Associations Between End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation, Cardiopulmonary Resuscitation Quality, and Survival. Circulation. 2024 Jan 30;149(5):367-378. doi: 10.1161/CIRCULATIONAHA.123.066659. Epub 2023 Nov 6.

What are your thoughts?