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The following is a summary of “Evaluating the Utility of End-Tidal CO₂ as a Predictor of Mortality in Trauma Victims: A Systematic Review and Meta-Analysis,” published in the December 2024 issue of Surgery by Al-Aomar et al.  

End-tidal carbon dioxide (ETCO₂) monitoring is an essential tool for assessing people with trauma in different healthcare settings. The arterial carbon dioxide (PaCO₂)-ETCO₂ gap helps evaluate the matching of lung ventilation and perfusion.  

Researchers conducted a retrospective study to evaluate how end-tidal CO₂ (ETCO₂) can predict mortality in people with trauma.  

They performed a systematic literature search (01/1990-06/2023) and included studies on adult patients with trauma with mortality outcomes, 17 studies were selected, including 3,445 patients (mean age 39.08 years; 22.3% female). The primary outcome was to assess the reliability of ETCO₂ measurements in predicting mortality.  

The results showed that mean ETCO₂ levels in survivors were 31.45 mmHg and 24.75 mmHg in deceased patients (P=0.0128). The mean PaCO₂ -ETCO₂ gap in survivors was 6.8 mmHg, while this was 15.0 mmHg in deceased patients (P<0.001). Using receiver operating characteristic curve analysis, an ETCO₂ level of 30.2 mmHg showed a high sensitivity for predicting mortality.  

They concluded that low ETCO₂ or a wide PaCO₂ -ETCO₂ gap were significantly associated with poor outcomes in people with trauma. Monitoring ETCO₂ could help identify those who need more aggressive treatment early in the care.  

Source: americanjournalofsurgery.com/article/S0002-9610(24)00682-2/abstract