Evaluating the utility of end-tidal CO2 as a predictor of mortality in trauma victims: A systematic review and meta-analysis

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2025-02-01 DOI:10.1016/j.amjsurg.2024.116130

Salma Al-Aomar , Jehad Feras AlSamhori , Hamza Alzghoul , Hatem Al-Ghraibeh , Ghayda'a Al-Majali , Samantha Tarras , Heather Dolman , James Tyburski , Gamal Mostafa , Awni D. Shahait

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Abstract

Background

Capnography has shown to be an invaluable tool in assessing trauma victims in different setups. To elucidate this, we conducted this meta-analysis to evaluate the utility of end-tidal CO₂ (ETCO₂) and the arterial CO₂ -ETCO₂ gap (PaCO₂-ETCO₂) measurements on predictiveness for mortality in trauma patients.

Methods

A systematic literature search was performed (01/1990–06/2023). The inclusion criteria included adult trauma patients, with mention of mortality. The primary outcome was evaluating the reliability of ETCO₂ in predicting mortality.

Results

Seventeen studies were included, with total of 3445 patients. Mean age was 39.08-year, 22.3 % female. Overall mortality was 25.6 %, mostly retrospective studies. Mean ETCO₂ in survivors was 31.45 mmHg, and 24.75 mmHg in deceased patients, (p = 0.0128). Mean PaCO₂-ETCO₂ gap in survivors was 6.8 mmHg, and 15.0 mmHg in deceased patients, (p < 0.001). Using receiver operator characteristic curve analysis, ETCO₂ of 30.2 mmHg with high sensitivity to predict mortality.

Conclusion

Low ETCO₂ or a wide PaCO₂-ETCO₂ gap were significantly correlated with poor outcomes in trauma patients. This easily obtained value can help predict those who need more aggressive treatments.

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评估终潮CO2作为创伤受害者死亡率预测因子的效用：系统回顾和荟萃分析。

背景：血管造影已被证明是评估不同情况下创伤受害者的宝贵工具。为了阐明这一点，我们进行了这项荟萃分析，以评估潮汐末CO2 （ETCO2）和动脉CO2-ETCO2间隙（PaCO2-ETCO2）测量对创伤患者死亡率预测的效用。方法：系统查阅文献（1990年1月~ 2023年6月）。纳入标准包括成人创伤患者，并提及死亡率。主要结局是评估ETCO2预测死亡率的可靠性。结果：纳入17项研究，共3445例患者。平均年龄39.08岁，女性22.3%。总体死亡率为25.6%，主要是回顾性研究。幸存者的平均ETCO2为31.45 mmHg，死亡患者的平均ETCO2为24.75 mmHg, （p = 0.0128）。幸存者PaCO2-ETCO2平均差值为6.8 mmHg，死亡患者PaCO2-ETCO2平均差值为15.0 mmHg (p = 30.2 mmHg)，对预测死亡率具有很高的敏感性。结论：低ETCO2或较大PaCO2-ETCO2间隙与创伤患者预后不良显著相关。这个容易获得的值可以帮助预测那些需要更积极治疗的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.