Capnography

"To reduce the risk of unrecognized tube misplacement or displacement, providers should use a device such as an exhaled CO₂ detector or an esophageal detector device to confirm endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any subsequent movement of the patient". (p. IV-52)

"No study, however, has identified a single device as both sensitive and specific for endotracheal tube placement in the trachea or esophagus...There is not data to quantify the capability of devices to monitor tube position after initial placement" (p. IV-54)

A study by Silvestri et al., was published after the deadline for AHA review. It shows the advantage of using continuous capnography in maintaining tube placement. No unrecognized misplaced intubations were found by paramedics who used continuous EtCO₂ monitoring. To order a reprint of this abstract, click here. You will be routed to our request page; please type "Silvestri Study" in the message box that appears. [1]

"In summary, end-tidal CO₂ monitoring during cardiac arrest can be useful as a noninvasive indicator of cardiac output generated during CPR." Class IIa. (p. IV-78)

"In infants and children with a perfusing rhythm, use a colorimetric detector or capnography to detect exhaled CO₂ to confirm endotracheal tube position in the prehospital and in-hospital settings." Class IIa. (p. IV-169)

"The self-inflating bulb (esophageal detector device) may be considered to confirm endotracheal placement in children weighing >20 kg with a perfusing rhythm." Class IIb. (p. IV-169)

"Exhaled CO₂ detection is effective for confirmation of endotracheal tube placement in infants, including very low birth weight infants." (p. IV-191)

Oridion capnography used in the LIFEPAK 12 defibrillator/monitor, can be used on neonates and small children as well as adults. The small sample size required for EtCO₂ detection is especially advantageous in the treatment of infants and small children.

"Monitor exhaled CO₂ (qualitative colorimetric detector or capnography) during interhospital or intrahospital transport of intubated patients." Class IIa. (p. IV-181) (pediatric patients)

It should be noted that even though colorimetric devices are permitted for monitoring correct tube placement they only monitor one point in time. If a tube becomes misplaced during transport, colorimetric devices will not detect it nor will it alert the provider. Capnography, especially using Oridion Microstream technology provides the most convenient way to continuously monitor EtCO₂ in a wide range of patients from infant to adult.