September 2004, MERGINET�The role of capnography is becoming more and more important in emergency medicine and EMS. It has been long thought that the end-tidal carbon dioxide level (PetCO 2 ) is an indicator of cardiac output and a marker for a pathophsyiological state.
In this study based at the Helicopter Emergency Medical Service of the Royal London Hospital in London, researchers evaluated the records for 191 blunt trauma patients who required prehospital rapid sequence intubation (RSI) and were treated between 1998 and 2001. They specifically compared the PetCO 2 20 minutes after intubation and compare it with patient survival to discharge. They found a median PetCO 2 at 20 minutes of 4.10 kPa (30.75 mmHg) in survivors and 3.50 kPa (26.25 mmHg) in non-survivors. Normal PetCO 2 is 3.5 to 4.5 kPa (26.25 mmHg to 33.75 mmHg). In this study, hyperventilation was not thought to be the cause of the hypocapnea. They concluded that only 5 percent of patients with a PetCO 2 less than 3.25 kPa (24.38 mmHg) survived to discharge. They also found that the PetCO 2 at 20 minutes post-intubation was a better indicator or survival than immediately after intubation. This is another study showing the utility of capnography in the field. Although there are no immediate changes in prehospital care mandated by this paper, it adds to the body of evidence that continuous wave-form capnography is quickly becoming a standard of care in EMS. Reference: Deakin CD, Sado DM, Coats TJ, Davies G. �Prehospital end-tidal carbon dioxide concentration and outcome in major trauma.� Journal of Trauma. 2004;57:65-68. --- URG-L Pour modifier votre adresse de courriel sur URG-L, envoyez un avis a [EMAIL PROTECTED] en indiquant votre nouvelle adresse ainsi que l'ancienne et le nom de la liste.
