Abstract
Objectives: To determine the availability of end-tidal CO2 measurement in confirmation of endotracheal tube placement in the non-arrest patient, and to assess its use in academic and non-academic emergency departments.
Methods: Emergency physicians in the USA were surveyed by mail in the beginning of the year 2000 regarding availability at their institution of both colorimetric/qualitative and quantitative end-tidal CO2 capnography, frequency of use in their own practice, and descriptor of their hospital (academic, community teaching, and community non-teaching). Additionally, data were obtained from the National Emergency Airway Registry 97 series (NEAR) about how many intubations used this method of confirmation. NEAR site coordinators were surveyed as well.
Results: Of 1000 surveys, 550 were returned (55%). Colorimetric technology existed in 77% of respondents' hospitals (n = 421); 25% of respondents (n = 138) had continuous monitoring capability. Physicians practising at academic hospitals were more likely to have continuous monitoring (36%; n = 196) than community teaching institutions (32%; n = 173) and non-teaching centres (18%; n = 100) (p<0.001). Among physicians who had this technology available, only 14% (n = 19) "always" used it in non-arrest intubations; 57% "rarely" or "never" employed it (n = 75). Among NEAR centres (institutions committed to monitoring current airway practices) only 12% of 6009 (n = 716) intubations used continuous end-tidal CO2 measurement. Of these practitioners, only 40% "always" used it (n = 6/15) (83% response rate (n = 29/35)).
Conclusions: Despite recommendations from national organisations that endorse continuous monitoring of end-tidal CO2 for confirming endotracheal tube placement, it is neither widely available nor consistently applied.
Full Text
The Full Text of this article is available as a PDF (57.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Clyburn P., Rosen M. Accidental oesophageal intubation. Br J Anaesth. 1994 Jul;73(1):55–63. doi: 10.1093/bja/73.1.55. [DOI] [PubMed] [Google Scholar]
- Hogg K., Teece S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Colourimetric CO(2) detector compared with capnography for confirming ET tube placement. Emerg Med J. 2003 May;20(3):265–266. doi: 10.1136/emj.20.3.265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kannan S., Manji M. Survey of use of end-tidal carbon dioxide for confirming tracheal tube placement in intensive care units in the UK. Anaesthesia. 2003 May;58(5):476–479. doi: 10.1046/j.1365-2044.2002.28934.x. [DOI] [PubMed] [Google Scholar]
- Li J. A prospective multicenter trial testing the SCOTI device for confirmation of endotracheal tube placement. J Emerg Med. 2001 Apr;20(3):231–239. doi: 10.1016/s0736-4679(00)00317-6. [DOI] [PubMed] [Google Scholar]
- MacLeod B. A., Heller M. B., Gerard J., Yealy D. M., Menegazzi J. J. Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection. Ann Emerg Med. 1991 Mar;20(3):267–270. doi: 10.1016/s0196-0644(05)80937-0. [DOI] [PubMed] [Google Scholar]
- O'Connor R. E., Swor R. A. Verification of endotracheal tube placement following intubation. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care. 1999 Jul-Sep;3(3):248–250. doi: 10.1080/10903129908958945. [DOI] [PubMed] [Google Scholar]
- Pelucio M., Halligan L., Dhindsa H. Out-of-hospital experience with the syringe esophageal detector device. Acad Emerg Med. 1997 Jun;4(6):563–568. doi: 10.1111/j.1553-2712.1997.tb03579.x. [DOI] [PubMed] [Google Scholar]