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Volume 22 Supplement 1

London Trauma Conference 2013

Can an initial end-tidal CO2 <1.33 kPa predict lack of return of spontaneous circulation during pre-hospital cardiac arrest?

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Previous results have indicated that an initial end-tidal (ET) CO2 < 1.33 may be used as a cut-off value for when return of spontaneous circulation (ROSC) can be achieved during pre-hospital cardiac arrest [1].

We aimed at validating these results in our anaesthesiologist-staffed pre-hospital critical care system.

Materials and methods

We prospectively registered data [2] according to the Utstein-style template for reporting data from pre-hospital advanced airway management [3] from February 1st 2011 to October 31st 2012. Included were consecutive patients at all ages with pre-hospital cardiac arrest treated by eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region.


We registered data from 595 cardiac arrest patients; in 58.9 % (n=350) of these cases the pre-hospital critical care teams performed pre-hospital endotracheal intubation.

An initial end-tidal CO2 measurement following pre-hospital endotracheal intubation were available in 270 cases.

We identified 22 patients, who had an initial ETCO2 below 1.33 kPa.

Four of these patients achieved return of spontaneous circulation. All four patients were admitted to hospital, three with stable circulation and one with ongoing automated CPR due to recurrent cardiac arrest.


Our results indicates that an initial ETCO2 below 1.33 kPa during pre-hospital cardiac arrest should not be used as a cut-off value for the achievability of return of spontaneous circulation.


  1. 1.

    Kolar M, Krizmaric M, Klemen P, Grmec S: Partial pressure of end-tidal carbon dioxide successful predicts cardiopulmonary resuscitation in the field: a prospective observational study. Critical care. 2008, 12: R115-10.1186/cc7009.

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    Rognas L, Hansen TM, Kirkegaard H, et al: Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2013, 21 (1): 58-10.1186/1757-7241-21-58.

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    Sollid SJ, Lockey D, Lossius HM: A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine. 2009, 17: 58-10.1186/1757-7241-17-58.

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Correspondence to Leif Rognås.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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  • Cardiac Arrest
  • Airway Management
  • Spontaneous Circulation
  • Cardiac Arrest Patient
  • Advanced Airway