What does this research mean for the field?

End-tidal carbon dioxide (ETCO2) is not significantly associated with chest compression quality in pediatric out-of-hospital cardiac arrest. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This study aims to investigate the relationship between end-tidal carbon dioxide levels and chest compression quality during pediatric out-of-hospital cardiac arrest.

March 12, 2026Open Access

Is End-Tidal Carbon Dioxide Indicative of Chest Compression Quality in Pediatric Out-of-Hospital Cardiac Arrest? A Video Review Study

Key Points

This study aims to investigate the relationship between end-tidal carbon dioxide levels and chest compression quality during pediatric out-of-hospital cardiac arrest.
Retrospective observational video review in a pediatric emergency department.
Included children under 18 years with out-of-hospital cardiac arrest from March 2021 to August 2022.
Collected ETCO2 values and chest compression data at 5-second intervals using audiovisual defibrillator data.
Evaluated compression quality based on American Heart Association metrics over one-minute epochs.
Thirty children with out-of-hospital cardiac arrest were analyzed, totaling 380 epochs of chest compression data.
Compression quality was primarily classified as low (35 epochs) or marginal (196 epochs), with few optimal compressions (10 epochs).
No significant association was found between ETCO2 levels and chest compression quality categories.
The correlation between ETCO2 and compression rate was weakly positive, while other quality metrics showed no significant correlation.

Abstract

Objectives: To determine if end-tidal carbon dioxide (ETCO 2 ) is associated with chest compression (CC) quality in pediatric patients presenting with outof-hospital cardiac arrest (OHCA).Methods: We conducted a retrospective, observational, video review-based study in a pediatric emergency department.Children <18 years with OHCA from March 2021 to August 2022 were included.We collected ETCO 2 values every 5 seconds via video review and CC data from an audiovisual defibrillator (Zoll R Series).CC data were evaluated in 1-minute epochs for compliance with American Heart Association (AHA) high-quality compression metrics for rate, depth, and CC fraction and categorized as low, marginal, adequate, or optimal.ETCO 2 was averaged over each minute, aligned with CC epochs, and analyzed using a linear mixed model.Results: Fifty patients presented with OHCA, and 30 were included yielding 380 total epochs.Compression quality was low in 35 epochs, marginal in 196 epochs, adequate in 139 epochs, and optimal in 10 epochs.There was no significant association between ETCO 2 and CC quality when comparing epoch categories.ETCO 2 had a weak positive correlation with target compression rate (r = 0.113, 95% CI 0.011, 0.213) but no significant correlation with target depth (r = -0.102,95% CI -0.202, 0.000) or chest compression fraction (CCF) (r = 0.055, 95% -0.046, 0.155).

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