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Introduction  Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determine the effectiveness of combination of clinical probability and end-tidal carbon dioxide (PetCO 2 ) for evaluation of suspected PE with abnormal concentrations of D-dimer in prehospital emergency setting.    Methods  We assessed clinical probability of PE and PetCO 2  measurement in 100 consecutive patients with suspected PE and positive D-dimer in the field. PetCO 2  > 28 mmHg was considered as the best cut-off point. PE was excluded or confirmed by hospital physicians in the University Clinical Center Maribor by computer tomography (CT), ventilation/perfusion scan echocardiography and pulmonary angiography.    Results  PE was confirmed in 41 patients. PetCO 2  had a sensitivity of 92.6% (95% CI, 79 to 98%), a negative predictive value of 94.2% (95% CI, 83 to 99%), a specificity of 83% (95% CI, 71 to 91%) and a positive predictive value of 79.2% (95% CI, 65 to 89%). Thirty-five patients (35%) had both a low (PE unlikely) clinical probability and a normal PetCO 2  (sensitivity: 100%, 95% CI: 89 to 100%) and twenty-eight patients (28%) had both a high clinical probability (PE likely) and abnormal PetCO 2  (specificity: 93.2%, 95% CI: 83 to 98%).    Conclusions  The combination of clinical probability and PetCO 2  may safely rule out PE in patients with suspected PE and positive D-dimer in the prehospital setting.

Capnometry in suspected pulmonary embolism with positive D-dimer in the field