End-Tidal CO2-Derived Values during Emergency Trauma Surgery Correlated with Outcome: A Prospective Study

BACKGROUND: The purpose of this study was to determine whether end-tidal carbon dioxide (PETCO) derived variables assist in evaluating the adequacy of resuscitation during emergency surgery for trauma. METHODS: This was a prospective study of end-tidal derived variables and outcome in 106 trauma patients in an urban Level I trauma center. RESULTS: The patients who lived (compared with those who died) had higher final end-tidal Pco levels, lower arterial-end tidal CO differences (Pa-ET)CO, and a decreased alveolar dead space ratio (p < 0.001). The best survival rates were with a PETCO > 27 mm Hg, a (Pa-ET)CO < or = 9 mm Hg, and 96% (56 of 58) for an alveolar dead space ratio < or = 0.20 (p < 0.001). An inappropriately high or "excess Paco also correlated with a decreased (Pa-ET)CO and poorer prognosis. If, after the initial resuscitation, the PETCO -derived values did not achieve these "optimal" levels, survival was significantly reduced. CONCLUSION: During emergency trauma surgery, the PETCO and its derived values help to predict outcome and may be used to identify patients needing more aggressive resuscitation.