The value of end-tidal CO2 value in shock staging in patient with advanced trauma life support

Introduction: Multiple trauma management is a team-work in emergency medicine. Traumatic shock management is important for patient's treatment and mortality. Objective findings guide bedsides in vital signs in recognizing shock findings. In this study, it was aimed to determine the association of base deficit in arterial blood gas and non-invasively examined ETCO2 value in predicting shock findings in multiple trauma patients. Material and Methods: Our study covers high energy trauma patients 18 aged and over, who were brought to our hospital. This study date between June 2019 and February 2020. ETCO2 values were evaluated with Emma Massimo Capnography device and arterial blood gas was taken from all patients who met the criteria of the study and who were research assistant in the emergency department or the specialist physician accepted high energy trauma. Classical shock parameters, demographic data, trauma scores and resuscitative procedures were recorded on the patient's study form. Results: In our study included 104 patient whom data were completed, 29 were female (27.9%) and 75 were male (72.1%). Age mean was founded 38.52. Patient's trauma type was founded 79 patient thorax (76%), 64 patient head-neck (61.5%) and extremity trauma 64 patient (61.5%). Systolic blood pressure mean was 108.95±23.2 mmHg, diastolic bold pressure mean was founded 67.6±14.9 mmHg. 22.2% of this patients systolic blood pressure was below 90 mmHg. It was found that 4 of the 36 patients (34.6%) needing blood products needed massive transfusion. Base deficit median was founded -4 (min. -26, max. 3, IQR -7 and -2), ETCO2 median was 30 mmHg (min. 13, max. 41, IQR 24-33). 79.8% of patients were founded to be hospitalized in the intensive care unit. Significant correlation was found in spearmen correlation analysis with base deficit and ETCO2 values (p=0.004). In Bland-Altman analysis, it was found that ETCO2 and base deficit coexisted. ETCO2 and base deficit were found to be valuable in predicting admission to the intensive care unit (ETCO2 AUC=0.505 (CI=0.372-0.637), base deficit AUC=0.588 (0.442-0.734). ETCO2 and BE values were found to be statistically significant in predicting mortality. ETCO2 was found to be valuable in ROC analysis performed with hypotension and tachycardia. In the spearmen analysis of the injury severity score, it was found that there was a significant correlation with ETCO2 (p˂0.01), and revise trauma score was weakly correlated (p˂0.05). Conclusion: ETCO2 value can be used as a non-invasive method to predict and manage shock in multiple trauma patients. Key Words: Multiple Trauma, Heamorrhagic Shock, ETCO2, Base Deficit