Carbon dioxide monitoring in emergency medicine training programs

Objectives: Although the measurement of carbon dioxide (CO₂) in breath is the standard of care for verification of endotracheal tube placement in all anesthesia practice and in the prehospital setting, there is currently no uniform consensus on the status of CO₂ monitoring in emergency medicine. We conducted this survey to delineate practice patterns of CO₂ monitoring in academic emergency medicine training programs and to describe the preference for type of CO₂ monitoring device. Methods: We surveyed the availability, presence, and types of CO₂ monitoring in all general emergency medicine (GEM) residency programs and all pediatric emergency medicine (PEM) fellowship programs. A two-question survey was used, and data were collected from March 1998 to June 1998. The clinicians surveyed were asked whether their emergency department (ED) used CO₂ monitoring for detection of endotracheal tube placement and, if so, what type of CO₂ monitoring devices was used. Types of CO₂ monitoring devices were categorized as colorimetric, capnometric, capnographic, or combinations of these. Results: Of the 168 programs surveyed, all GEM and PEM programs responded, and the survey results showed that 136 of 168 (81%) used some form of CO₂ monitoring, and 32 of 168 (19%) did not use CO₂ monitoring. The majority of programs (115/168, 68%) used a single device. Colorimetric devices were used most frequently (76/168, 45%), and capnometry was used the least (9/168, 5%). PEM programs had a significant preference for quantitative CO₂ monitoring, whereas GEM programs had a significant preference for qualitative CO₂ monitoring. Conclusions: Although the majority of academic emergency medicine training programs used CO₂ monitoring, 19% did not. Colorimetric devices were the most frequently used CO₂ monitoring technology.