Acceso usuarios
Lorena Pérez Martos
, L. Zaraín Obrador, Francisco de Paula Delgado Moya, María Bringas Bollada, Iván Huercio Martínez, Ervigio Corral Torres
OBJETIVO. Analizar la capacidad predictiva precoz del ETCO2 en el paciente traumático intubado a nivel prehospitalario, para determinar la existencia o no de shock hemorrágico (SH). Evaluar si valores bajos de ETCO2 se relacionan con necesidad de concentrados de hematíes (CH) y mortalidad.
MATERIAL Y MÉTODOS. Estudio observacional retrospectivo de una cohorte de pacientes traumáticos intubados, atendidos por un servicio de emergencias extrahospitalarias entre 2021 y 2024. Se diferenciaron dos grupos, pacientes con SH y sin shock hemorrágico (NSH).
RESULTADOS. Se estudiaron 108 pacientes: edad media de 40,34 años y 74,1% de hombres. Cuarenta y ocho pacientes con NSH y 60 pacientes con SH. Se observó asociación significativa entre ETCO y SH: ETCO2 inicial 43,50 mmHg en NSH frente a 33,42 mmHg en SH, p < 0,001 y OR de 0,79 (0,70-0,88). Se calculó el índice de Youden, obteniendo como punto de corte para SH un ETCO2 de 37,5 mmHg. Asociación significativa entre ETCO2 y mortalidad: ETCO2 de 39,63 mmHg en supervivientes vs 29,79 mmHg en fallecidos, p < 0,001. Se objetivó una correlación negativa significativa (Corrrelación de Pearson –0,35, p < 0,001) entre ETCO2 y la necesidad de CH.
CONCLUSIONES. Los pacientes con SH presentan valores prehospitalarios de ETCO2 significativamente más bajos. Valores bajos de ETCO2 se asocian a necesidad de CH y mortalidad.
OBJECTIVE. To analyze the early predictive capacity of prehospital end-tidal carbon dioxide (ETCO2) in intubated trauma patients to determine the presence or absence of hemorrhagic shock (HS). Additionally, to assess whether low ETCO2 values are associated with the need for red blood cell (RBC) transfusion and mortality.
MATERIALS AND METHODS. We conducted a retrospective observational study using a prospective database and went on to analyze a cohort of intubated trauma patients attended by an out-of-hospital emergency service from 2021 through 2024. Patients were categorized into 2 groups: those with HS and those without it (NHS). Prehospital and hospital criteria were established for HS diagnosis. A univariate analysis was performed using the Student's t test for all independent variables. Binary logistic regression was conducted on variables with statistical significance.
RESULTS. A total of 108 patients were studied (mean age of 40.34 years; 74.1% men). A total of 48 patients were categorized as NHS, and 60 as HS. A significant association was observed between ETCO2 and HS: initial ETCO2 was 43.50 mmHg in NHS vs 33.42 mmHg in HS (P < .001, OR, 0.79 [0.70-0.88]). The Youden index was calculated, identifying a cut-off point for HS at an ETCO2 of 37.5 mmHg. Additionally, a significant association was found between ETCO2 and mortality: ETCO2 was 39.63 mmHg in survivors vs 29.79 mmHg in non-survivors (P < .001). A significant negative correlation was identified between ETCO2 and RBC transfusion requirements (Pearson correlation: -0.35; P < .001).
CONCLUSIONS. Patients with HS have significantly lower prehospital ETCO2 values. Low ETCO2 values are associated with RBC transfusion needs and increased mortality.
