Photo Credit: EvgeniyShkolenko

The following is a summary of “Prospective randomized evaluation of transcutaneous carbon dioxide monitoring during complex electrophysiological procedures under deep sedation: the TRACES trial,” published in the November 2024 issue of Cardiology by Teumer et al.  

Electrophysiology (EP) procedures are expanding rapidly, necessitating sedation for patient comfort and immobility; however, sedatives and analgesics can lead to respiratory depression, increasing risks of hypercapnia, hypoxia, and hypotension.  

Researchers conducted a prospective study to assess the impact of transcutaneous carbon dioxide (CO₂) monitoring on patient safety during EP procedures under deep sedation.  

They conducted a study at Ulm University Heart Center involving 726 patients receiving deep sedation for EP procedures (August 2019 and October 2023). Patients were randomly assigned to either standard monitoring or standard monitoring with continuous transcutaneous CO₂ monitoring (TCM-group). Standard monitoring included non-invasive blood pressure (BP), oxygen saturation (SpO₂), and frequent peripheral venous blood gas (VBG) analysis. The primary composite endpoint assessed SpO₂ dips below 90% and pathological changes in VBG analysis.  

The results showed that 195 patients (54.8%) in the TCM group and 195 patients (56.5%) in the standard group met the primary composite endpoint (P=0.642). Peripheral venous CO₂ partial pressure (pCO₂) increased by over 30% from baseline more frequently in the standard group than in the TCM-group (P=0.005). Additionally, venous pH below 7.25 occurred more often in the standard group (P=0.047).  

They concluded that although TCM did not improve the primary combined endpoint but mitigated significant pCO₂ increases and respiratory acidosis.  

Source: link.springer.com/article/10.1007/s00392-024-02570-8