Association of end-tidal carbon dioxide levels during cardiopulmonary resuscitation with survival in a large paediatric cohort

Aim: To examine the associations between ETCO₂, ROSC, and chest compression quality markers in paediatric patients during active resuscitation. Methods: This was a single-centre cohort study of data collected as part of an institutional prospective quality initiative improvement program that included all paediatric patients who received chest compressions of any duration from January 1, 2013, through July 10, 2018, in the Johns Hopkins Children's Center. Data was collected from Zoll R Series® defibrillators. Events were included if Zoll data files contained both chest compression and ETCO₂ data. 2,746 minutes corresponding to 143 events were included in the analyses. Results: The median event ETCO₂ for all 143 events was 16.8 [9.3–26.3] mmHg. There was a significant difference in median event ETCO₂ between events that achieved ROSC and those that did not (ROSC: 19.3 [14.4–26.6] vs. NO ROSC: 13.9 [6.6–25.5] mmHg; p < 0.05). When the events were based on patient age, this relationship held in adolescents (ROSC: 18.8 [15.5–22.3] vs. NO ROSC: 9.6 [4.4–15.9] mmHg; p < 0.05), but not in children or infants. Median event ETCO₂ was significantly associated with chest compression rate less than 140 (p < 0.0001) and chest compression fraction 90–100 (p < 0.0001). Conclusions: This represents the largest collection of ETCO₂ and chest compression data in paediatric patients to date and unadjusted analyses suggests an association between ETCO₂ and ROSC in some paediatric patients.