Abstract
Background: Cardiac surgery requires careful and ongoing monitoring to guarantee the best possible outcomes for patients. One non-invasive indicator of ventilation and perfusion that has gained attention is end-tidal carbon dioxide (ETCO2). This systematic review investigates the clinical usefulness and dependability of ETCO2 in open cardiac surgery.
Methods: A comprehensive search across five databases included studies from January 1990 until January 2025. Eligibility criteria encompassed observational studies and clinical trials utilizing ETCO2 measurements in adults. Study selection involved duplicate removal and independent screening. Data extraction focused on clinical parameters. Risk of bias assessment used the Newcastle-Ottawa Scale (NOS) and the Risk-of-Bias tool for randomized trials-2 (RoB-2). Narrative synthesis summarized ETCO2 trends and associations, without conducting a meta-analysis.
Results: The database search identified 106 articles, with 26 duplicates removed. After title and abstract screening, 19 studies underwent full-text review, leaving five studies in the final analysis. These studies included 169 patients from Australia, Iran, Lebanon, Russia, and the United States. Patients had a mean age of 62.3 years and a body mass index (BMI) of 28.43 kg/m2. ETCO2 showed strong correlations with arterial partial pressure of carbon dioxide (PaCO2), as well as cardiac output and successful weaning and extubation.
Conclusion: ETCO2 may provide useful continuous noninvasive information during selected phases of cardiac surgery; however, the available evidence remains exploratory. ETCO2 should be considered an adjunct rather than a replacement for arterial blood gas monitoring.
Jehad Feras Alsamhori, Abdel Rahman Feras Alsamhori, Zaid M. Abdelsattar, Amjad Bani Hani, Andrea Loggini, Awni D. Shahait
