Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T14:59:08.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a Semi-Quantitative CO2 Monitor with Pulse Oximetry for Prehospital Endotracheal Tube Placement and Management

Published online by Cambridge University Press:  28 June 2012

Shawn George  and
Andrew J. Macnab
Shawn George
Affiliation:
British Columbia Ambulance Service, Department of Pediatrics, Vancouver, British Columbia, Canada University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
Andrew J. Macnab*
Affiliation:
British Columbia Ambulance Service, Department of Pediatrics, Vancouver, British Columbia, Canada University of British Columbia, Department of Pediatrics, Vancouver, British Columbia, Canada
*
Critical Care Office, 2L5 Children's and Women's Hospital of BC, 4480 Oak Street Vancouver, British Columbia, V6H 3V4 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or inter-facility use.

Methods:

Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use.

Results:

The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The “breath beep” feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe.

Conclusions:

“Breath beeps” were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.

Keywords

advanced life support (ALS)capnometryCO2 detectorinterfacility transportparamedicpre-hospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 17 , Issue 1 , March 2002 , pp. 38 - 41
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ragosta, K, Kanter, RK: Airway management. In Pediatric Transport Medicine, McCloskey, K, Orr, R (eds), Mosby: St Louis, 1995.Google Scholar
2. Cardoso, MM, Banner, MJ, Melker, RJ, Bjoraker, DG: Portable devices used to detect endotracheal intubation during emergency situations: review. Crit Care Med 1998; 26(5): 957–964.CrossRefGoogle ScholarPubMed
3. Hawkins, J, Noah, Z: Equipment. In: Pediatric Transport Medicine. McCloskey, K, Orr, R (eds), Mosby: St Louis, 1995.Google Scholar
4. American Academy of Pediatrics ACP Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. Elk Grave Village, Il: Americam Academy of Pediatrics 1999.Google Scholar
5. White, SJ, Slovis, CM: Inadvertent esophageal intubation in the field: Reliance on a fool's 'gold standard'. Acad Emerg Med 1997; 4(2): 89–90.CrossRefGoogle ScholarPubMed
6. White, SJ, Slovis, CM: Response to comments. Acad Emerg Med 1997; 4(9): 929–991Google Scholar
7. Macnab, AJ, MacPhail, I, Macnab, MK, Noble, R, O'Flaherty, D: A comparison of intubation success for paediatric transport team paramedics using lighted vs regular tracheal tube stylets. Paediatric Anaesthesia 1998; 8: 215–220.CrossRefGoogle ScholarPubMed
8. Davey, A, Macnab, AJ, Green, G: Changes in pCO2 during air medical transport of children with closed head injuries. Air Med J 2001; 20(4): 27–30.CrossRefGoogle ScholarPubMed
9. MacLeod, BA, Heller, MB, Gerard, J, Yealy, DM, Menegazzi, JJ: Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection. Ann Emerg Med 1991; 20(3): 267–270.CrossRefGoogle ScholarPubMed
10. Sanders, AB: Capnography in emergency medicine. Ann Emerg Med 1989; 18(12): 1287–1290.CrossRefGoogle Scholar
11. Roizen, MF, Schreider, B, Austin, W, Carter, C, Polk, S: Pulse oximetry, cap-nometry, and blood gas measurements: Reducing cost and improving the quality of care with technology. J Clin Monit 1193; 9(4): 237–240.CrossRefGoogle Scholar
12. Macnab, AJ, Chen, Y, Gagnon, FA, Bora, B, Laszlo, C: Vibration and noise in pediatric emergency transport vehicles: A potential cause of morbidity? Aviat Space Environ Med 1995; 66: 212–219.Google ScholarPubMed