Low initial pre-hospital end-tidal carbon dioxide predicts inferior clinical outcomes in trauma patients

被引：7

作者：

Bryant, Mary Kate ^{[1
,2
]}

Tremont, Jaclyn N. Portelli ^{[1
,2
]}

Patel, Zachary ^{[1
]}

Cook, Nicole ^{[1
]}

Udekwu, Pascal ^{[1
]}

Reid, Trista ^{[2
]}

Maine, Rebecca G. ^{[3
]}

Moore, Scott M. ^{[1
]}

机构：

[1] WakeMed Hlth & Hosp, Dept Gen Surg & Trauma, Raleigh, NC 27610 USA

[2] Univ N Carolina, Dept Surg, Chapel Hill, NC 27515 USA

[3] Univ Washington, Dept Surg, 3024 New Bern Ave,Suite 302, Seattle, WA USA

来源：

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2021年 / 52卷 / 09期

关键词：

Trauma; End-tidal carbon dioxide; Hemorrhagic shock; Clinical outcomes; Triage; MASSIVE TRANSFUSION; SERUM LACTATE; VALUES; EPIDEMIOLOGY; UTILITY; SHOCK; RISK;

D O I：

10.1016/j.injury.2021.07.019

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Current guidelines continue to lead to under-and over-triage of injured patients in the pre hospital setting. End-tidal carbon dioxide (ETCO2) has been correlated with mortality and hemorrhagic shock in trauma patients. This study examines the correlation between ETCO2 and in-hospital outcomes among non-intubated patients in the pre-hospital setting. Methods: We retrospectively studied a cohort of non-intubated adult trauma patients with initial pre hospital side-stream capnography-obtained ETCO2 presenting via ground transport from a single North Carolina EMS agency to a level one trauma center from January 2018 to December 2018. Using the Liu method, the optimal threshold for low ETCO2 was <= 28.5 mmHg. Results: Initial pre-hospital ETCO2 was recorded for 324 (22.0%) of 1473 patients with EMS data. Patients with low ETCO2 (N = 98, 30.3% of cohort) were older (median 58y vs 45y), but mechanisms of injury and scene vital signs were similar (p > 0.05) between low and normal/high ETCO2 cohorts. Median injury severity score (ISS) did not differ significantly between the low and normal/high ETCO2 groups (5 vs 8, p = 0.48). Compared to normal/high ETCO2, low ETCO2 correlated with increased unadjusted odds of mortality (OR 5.06), in-hospital complications (OR 2.06), and blood transfusion requirement (OR 3.05), p < 0.05. Low ETCO2 was associated with 7.25 odds of mortality (95% CI 2.19,23.97, p = 0.001) and 3.94 odds of blood transfusion (95% CI 1.32-11.78) after adjusting for age, ISS, and scene GCS. All but one of the massive transfusion patients (N = 8/9) had a low pre-hospital ETCO2. Conclusions: Low initial pre-hospital ETCO2 associates with poor clinical outcomes despite similar ISS and mechanisms of injury. ETCO2 is a potentially useful pre-hospital point-of-care tool to aid triage of trauma patients as it may identify hemorrhaging patients and predict mortality. 0 2021 Elsevier Ltd. All rights reserved.

引用

页码：2502 / 2507

页数：6

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