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Background  During cardiac arrest, end-tidal carbon dioxide (ETCO 2 ) monitoring is recommended as a chest compression performance indicator. However, its frequency of use during out-of-hospital cardiac arrest (OHCA) and its benefits have never been evaluated in real clinical situations.    Objective  We investigated OHCA patients in Taiwan to evaluate the frequency of ETCO 2  monitoring and its effects on sustained return of spontaneous circulation (ROSC).    Methods  We sampled the Taiwan National Health Insurance claims database, which contains 1 million beneficiaries. All adult beneficiaries older than 18 years who presented with OHCA and received chest compression between 1 January 2005 and 31 December 2012 were enrolled. We further identified patients with ETCO 2  monitoring and matched each 1 with 20 patients who did not receive ETCO 2  monitoring based on their propensity scores. A simple conditional logistic regression model was applied to compare the odds ratio (OR) for sustained ROSC in the matched cohorts.    Results  A total of 5041 OHCA patients were enrolled. The frequency of ETCO 2  monitoring has increased since 2010 but still is low. After matching, 53 patients with ETCO 2  monitoring and 1060 without ETCO 2  monitoring were selected. The OR of sustained ROSC in the ETCO 2  group was significantly increased (2.38, 95 % CI 1.28–4.42).    Conclusion  Patients who received ETCO 2  monitoring during OHCA had a higher possibility of sustained ROSC, but the overall use of ETCO 2  monitoring is still low despite strong recommendations for its use.    Electronic supplementary material  The online version of this article (doi:10.1186/s13049-015-0187-y) contains supplementary material, which is available to authorized users.

scandinavian journal of trauma, resuscitation and emergency medicine

End-tidal carbon dioxide monitoring may be associated with a higher possibility of return of spontaneous circulation during out-of-hospital cardiac arrest: a population-based study