Background: In a smaller experience, the authors previously demonstrated that end-tidal carbon dioxide (PetCO2)\r\nand cardiac output (CO) had a positive association in emergently intubated trauma patients during Emergency\r\nDepartment resuscitation. The aim of this larger study was to reassess the relationship of PetCO2 with CO and\r\nidentify patient risk-conditions influencing PetCO2 and CO values.\r\nMethods: The investigation consists of acutely injured trauma patients requiring emergency tracheal intubation.\r\nThe study focuses on the prospective collection of PetCO2 and noninvasive CO monitor (NICOM�®) values in the\r\nEmergency Department.\r\nResults: From the end of March through August 2011, 73 patients had 318 pairs of PetCO2 (mm Hg) and CO\r\n(L/min.) values. Mean data included Injury Severity Score (ISS) =15 in 65.2%, Glasgow Coma Score of 6.4 �± 4.6,\r\nhypotension in 19.0%, and death in 34.3%. With PetCO2 = 25 (15.9 �± 8.0), systolic blood pressure was 77.0 �± 69, CO\r\nwas 3.2 �± 3.0, cardiac arrest was 60.4%, and mortality was 84.9%. During hypotension, CO was lower with major\r\nblood loss (1.9), than without major loss (5.0; P = 0.0008). Low PetCO2 was associated with low CO (P < 0.0001). Low\r\nPetCO2 was associated (P = 0.0012) with ISS > 20, hypotension, bradycardia, major blood loss, abnormal pupils,\r\ncardiac arrest, and death. Low CO was associated (P = 0.0059) with ISS > 20, hypotension, bradycardia, major blood\r\nloss, abnormal pupils, cardiac arrest, and death.\r\nConclusions: During emergency department resuscitation, a decline in PetCO2 correlates with decreases in\r\nnoninvasive CO in emergently intubated trauma patients. Decreasing PetCO2 and declining NICOM CO are\r\nassociated with hemodynamic instability, hemorrhage, abnormal pupils, and death. The study indicates that NICOM\r\nCO values are clinically discriminate and have physiologic validity.
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