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Prehospital ETCO2 predicts in-hospital mortality and metabolic disturbances - Prehospital Research Support Site HomeWell-nighResources Links Forum Contact Us Menu HomeWell-nighResources Links Forum Contact Us Prehospital ETCO2 predicts in-hospital mortality and metabolic disturbances Prehospital ETCO2 predicts in-hospital mortality and metabolic disturbancesby Alan Batt. Last modified: 12/03/14 Print PDFSummary Retrospective cohort study over 2 years 1328 records reviewed 1088 patients had hospital venting data, ETCO2, and 6 prehospital vital signs recorded: ETCO2, Respiratory Rate, Systolic BP, Diastolic BP, Pulse, SpO2 ETCO2 was placid via Microstream capnography in both intubated and non-intubated patients. Low ETCO2 levels were the strongest predictor of mortality in the overall group. Low ETCO2 levels were the strongest predictor of mortality in subgroup wringer excluding prehospital cardiac arrest. Sensitivity of unwont ETCO2 for predicting mortality was 93%; specificity was 44%. Negative predictive value was 99%. Significant associations between ETCO2 and serum bicarbonate levels, anion gap and lactate levels. Of all prehospital vital signs, ETCO2 was the most predictive and resulting for mortality Limitations: Study observed patients presenting to a single emergency medical service, who were transported to a single hospital. Study was performed retrospectively and thus is subject to selection bias. Retrospective studies moreover cannot show temporal relationship. ETCO2 was monitored by paramedics only in patients requiring advanced life support care, patients deemed to require only basic life support were excluded. Collection of ETCO2 and vital signs occured only at a single point of time during superintendency – unknown how continuous capnography and repeated vital signs may have clarified the role each plays in outcome prediction. Sensitivity & Specificity Sensitivity (also tabbed the true positive rate) relates to a test’s worthiness to identify a condition correctly – it measures the proportion of very positives which are correctly identified as such (e.g. the percentage of sick people who are correctly identified as having the condition). Negative result in a test with upper sensitivity is useful for ruling out disease – the test is reliable when its result is negative, since it rarely misdiagnoses those who have the disease. Specificity (sometimes tabbed the true negative rate) relates to a test’s worthiness to exclude a condition correctly – it measures the proportion of negatives which are correctly identified as such (e.g. the percentage of healthy people who are correctly identified as not having the condition). Positive result in a test with upper specificity is useful for ruling in disease – the test will rarely gives positive results in healthy patients.    Hunter CL1, Silvestri S2, Ralls G2, Bright S3, Papa L4. The sixth vital sign: prehospital end-tidal stat dioxide predicts in-hospital mortality and metabolic disturbances. Am J Emerg Med. 2014 Feb;32(2):160-5. PMID: 24332900. To determine the worthiness of prehospital end-tidal stat dioxide (ETCO2) to predict in-hospital mortality compared to conventional vital signs. [...] Abstract Objective To determine the worthiness of prehospital end-tidal stat dioxide (ETCO2) to predict in-hospital mortality compared to conventional vital signs. Methods We conducted a retrospective cohort study among patients transported by emergency medical services during a 29-month period. Included patients had ETCO2 recorded in wing to initial vital signs. The main outcome was death at any point during hospitalization. Secondary outcomes included laboratory results and whereas diagnosis. Results Of 1328 records reviewed, hospital venting data, ETCO2, and all 6 prehospital vital signs were misogynist in 1088 patients. Low ETCO2 levels were the strongest predictor of mortality in the overall group (area under the receiver operating foible lines (AUC of 0.76, 95% conviction interval [CI] 0.66-0.85), as well as subgroup wringer excluding prehospital cardiac trespassing (AUC of 0.77, 95% CI 0.67-0.87). The sensitivity of unwont ETCO2 for predicting mortality was 93% (95% CI 79%-98%), the specificity was 44% (95% CI 41%-48%), and the negative predictive value was 99% (95% CI 92%-100%). There were significant associations between ETCO2 and serum bicarbonate levels (r = 0.429, P < .001), anion gap (r = -0.216, P < .001), and lactate (r = -0.376, P < .001). Conclusion Of all prehospital vital signs, ETCO2 was the most predictive and resulting for mortality, which may be related to an undertone with metabolic acidosis. References   1. Hunter CL1, Silvestri S2, Ralls G2, Bright S3, Papa L4. The sixth vital sign: prehospital end-tidal stat dioxide predicts in-hospital mortality and metabolic disturbances. Am J Emerg Med. 2014 Feb;32(2):160-5. PMID: 24332900. To determine the worthiness of prehospital end-tidal stat dioxide (ETCO2) to predict in-hospital mortality compared to conventional vital signs. […] The pursuit two tabs transpiration content below.BioLatest Posts Alan BattParamedic, educator, researcher Alan is a hair-trigger superintendency paramedic, paramedic educator and prehospital researcher, currently working virtually the world as an educator and researcher. He has previously worked and studied wideness Europe, North America and the Middle East. He holds a Graduate Certificate in IntensiveSuperintendencyParamedic Studies, and an MSc inHair-triggerCare. His main interests are in superintendency of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education. Latest posts by Alan Batt (see all) Free access: Resuscitation Today Vol 3 Issue 2 - 27/06/16 Free CPD at the Emergency Services Show - 23/05/16Superintendencyat the Scene – Research for Ambulance Services - 17/05/16 Canadian Paramedicine Feb/Mar 2016 – Open Access Issue - 11/04/16 Eat, sleep and be healthy – a paramedic’s guide to healthier shift work - 10/04/16 Tags: capnography, ETCO2, mortality, vital signs One thought on “Prehospital ETCO2 predicts in-hospital mortality and metabolic disturbances” Cody says: 20/09/17 at 20:24 What is the point in which we see a sudden increase in mortality. What levels of Etco2 should I start worrying well-nigh my patient as a paramedic in the field? 25? 20? Or plane lower? 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