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A Prognostic Indicator for Survival

Arthur B. Sanders, MD; Karl B. Kern, MD; Charles W. Otto, MD; Melinda M. Milander, RN; Gordon A. Ewy, MD

JAMA. 1989;262(10):1347-1351.

Abstract
The effectiveness of ongoing cardiopulmonary resuscitation efforts is difficult to evaluate. Recent studies suggest that carbon dioxide excretion may be a useful noninvasive indicator of resuscitation from cardiac arrest. A prospective clinical study was done to determine whether end-tidal carbon dioxide monitoring during cardiopulmonary resuscitation could be used as a prognostic indicator of resuscitation and survival. Thirty-five cardiac arrests in 34 patients were monitored with capnometry during cardiopulmonary resuscitation during a 1-year period. Nine patients who were successfully resuscitated had higher average end-tidal carbon dioxide partial pressures during cardiopulmonary resuscitation than 26 patients who could not be resuscitated (15±4 vs 7±5 mm Hg). The 3 patients who survived to leave the hospital had a higher average end-tidal carbon dioxide partial pressure than the 32 nonsurvivors (17 ± 6 vs 8 ± 5 mm Hg). All 9 patients who were successfully resuscitated had an average end-tidal carbon dioxide partial pressure of 10 mm Hg or greater. No patient with an average end-tidal carbon dioxide partial pressure of less than 10 mm Hg was resuscitated. Data from this prospective clinical trial indicate that findings from end-tidal carbon dioxide monitoring during cardiopulmonary resuscitation are correlated with resuscitation from and survival of cardiac arrest.

(JAMA. 1989;262:1347-1351)

Author Affiliations
From the Sections of Emergency Medicine (Dr Sanders) and Cardiology (Drs Kern and Ewy and Ms Milander), and the Departments of Surgery (Dr Sanders), Internal Medicine (Drs Sanders, Kern, Otto, and Ewy and Ms Milander), Family-Community Medicine (Dr Sanders), and Anesthesiology (Dr Otto), University of Arizona Health Sciences Center, Tucson.

Footnotes
Reprint requests to Section of Emergency Medicine, University of Arizona Health Sciences Center, 1501 N Campbell, Tucson, AZ 85724 (Dr Sanders).

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