Is End-Tidal Carbon Dioxide Indicative of Chest Compression Quality in Pediatric Out-of-Hospital Cardiac Arrest? A Video Review Study.
Journal of the American College of Emergency Physicians open · 2026-03-08 · Observational study
Abstract
OBJECTIVES: To determine if end-tidal carbon dioxide (ETCO2) is associated with chest compression (CC) quality in pediatric patients presenting with out-of-hospital cardiac arrest (OHCA). METHODS: We conducted a retrospective, observational, video review-based study in a pediatric emergency department. Children <18 years with OHCA from March 2021 to August 2022 were included. We collected ETCO2 values every 5 seconds via video review and CC data from an audiovisual defibrillator (Zoll R Series). CC data were evaluated in 1-minute epochs for compliance with American Heart Association (AHA) high-quality compression metrics for rate, depth, and CC fraction and categorized as low, marginal, adequate, or optimal. ETCO2 was averaged over each minute, aligned with CC epochs, and analyzed using a linear mixed model. RESULTS: Fifty patients presented with OHCA, and 30 were included yielding 380 total epochs. Compression quality was low in 35 epochs, marginal in 196 epochs, adequate in 139 epochs, and optimal in 10 epochs. There was no significant association between ETCO2 and CC quality when comparing epoch categories. ETCO2 had a weak positive correlation with target compression rate (r = 0.113, 95% CI [0.011, 0.213]) but no significant correlation with target depth (r = -0.102, 95% CI [-0.202, 0.000]) or chest compression fraction (CCF) (r = 0.055, 95% [-0.046, 0.155]). CONCLUSION: In our small, single-center study, we found ETCO2 was minimally associated with compression rate but not depth or CCF and overall may be of limited utility in evaluating CC quality in pediatric OHCA. Our study was limited by the lack of optimal CC quality and unknown downtime.