Emergency medicine journal : EMJ · 2026
Prognostic accuracy of end-tidal carbon dioxide in cardiac arrest: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Lee Yi-Chih, Lo Yu-Tai, Chen Chen-Bin, Cheng Tzu-Heng, Seak Chen-June, Yen Chieh-Ching
Аннотация
BACKGROUND: Cardiac arrest, a critical emergency with high fatality rates, needs accurate early predictors of resuscitation outcomes. End-tidal carbon dioxide (ETCO2) monitoring, reflecting tissue perfusion and metabolic activity, is highlighted in guidelines for predicting return of spontaneous circulation (ROSC). This systematic review and meta-analysis evaluates the prognostic accuracy of ETCO2 at various time points and cut-offs to enhance clinical decision-making during cardiac arrest.
METHODS: A systematic search of MEDLINE, Embase and the Cochrane Library identified relevant prognostic accuracy studies. Inclusion criteria were original articles reporting prognostic accuracy of ETCO2 for ROSC prediction in adult cardiac arrest patients. Sensitivity, specificity and 95% CIs were calculated for ETCO2 measurements at initial, 10 and 20 min using 2×2 contingency tables. A multiple thresholds model was used for meta-analysis, and the Median of Medians method analysed median ETCO2 values.
RESULTS: Fourteen studies with 3186 cardiac arrest patients were included. The optimal ETCO2cut-off was 19.8 mm Hg at initial (sensitivity 0.75 (95% CI 0.60 to 0.85), specificity 0.53 (95% CI 0.40 to 0.65)), 15.7 mm Hg at 10 min (sensitivity 0.91 (95% CI 0.72 to 0.97), specificity 0.68 (95% CI 0.56 to 0.78)) and 8.5 mm Hg at 20 min (sensitivity 0.95 (95% CI 0.53 to 0.99), specificity 0.78 (95% CI 0.39 to 0.95)). The highest area under the curve (AUC) was 0.88 (95% CI 0.31 to 0.98) at 20 min, followed by 0.82 (95% CI 0.61 to 0.91) at 10 min and 0.67 (95% CI 0.57 to 0.75) initially.
CONCLUSIONS: While initial ETCO2 demonstrates limited prognostic accuracy for ROSC with a pooled AUC of only 0.67, ETCO2 measurements taken at 10 and 20 min provide a negative predictive value exceeding 0.95 when using a cut-off of 10 mm Hg. However, to meet the stringent criteria for termination of resuscitation (TOR) decisions, a lower cut-off, such as 5 mm Hg, or the incorporation of additional prognostic indicators would be necessary. Serial ETCO2 monitoring could also be considered as a potential adjunct in current TOR guidelines. Significant variability between studies necessitates cautious interpretation of these results.
PROSPERO REGISTRATION NUMBER: CRD42024527811.
METHODS: A systematic search of MEDLINE, Embase and the Cochrane Library identified relevant prognostic accuracy studies. Inclusion criteria were original articles reporting prognostic accuracy of ETCO2 for ROSC prediction in adult cardiac arrest patients. Sensitivity, specificity and 95% CIs were calculated for ETCO2 measurements at initial, 10 and 20 min using 2×2 contingency tables. A multiple thresholds model was used for meta-analysis, and the Median of Medians method analysed median ETCO2 values.
RESULTS: Fourteen studies with 3186 cardiac arrest patients were included. The optimal ETCO2cut-off was 19.8 mm Hg at initial (sensitivity 0.75 (95% CI 0.60 to 0.85), specificity 0.53 (95% CI 0.40 to 0.65)), 15.7 mm Hg at 10 min (sensitivity 0.91 (95% CI 0.72 to 0.97), specificity 0.68 (95% CI 0.56 to 0.78)) and 8.5 mm Hg at 20 min (sensitivity 0.95 (95% CI 0.53 to 0.99), specificity 0.78 (95% CI 0.39 to 0.95)). The highest area under the curve (AUC) was 0.88 (95% CI 0.31 to 0.98) at 20 min, followed by 0.82 (95% CI 0.61 to 0.91) at 10 min and 0.67 (95% CI 0.57 to 0.75) initially.
CONCLUSIONS: While initial ETCO2 demonstrates limited prognostic accuracy for ROSC with a pooled AUC of only 0.67, ETCO2 measurements taken at 10 and 20 min provide a negative predictive value exceeding 0.95 when using a cut-off of 10 mm Hg. However, to meet the stringent criteria for termination of resuscitation (TOR) decisions, a lower cut-off, such as 5 mm Hg, or the incorporation of additional prognostic indicators would be necessary. Serial ETCO2 monitoring could also be considered as a potential adjunct in current TOR guidelines. Significant variability between studies necessitates cautious interpretation of these results.
PROSPERO REGISTRATION NUMBER: CRD42024527811.