Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device

Joseph P. Ornato, Joshua B. Shipley, Edward M. Racht, Corey M. Slovis, Keith D. Wrenn, Paul E. Pepe, Sherri Lyne Almeida, Vicki F. Ginger, Terry V. Fotre

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Study objectives: To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. Type of participants: Adult patients were included if an endotracheal tube was inserted by prehospital care providers or emergency physicians for cardiac arrest, respiratory arrest, respiratory insufficiency, or airway protection. Design and interventions: A small, portable, colorimetric ETCO2 detector was attached to the endotracheal tube immediately after each attempted endotracheal tube insertion. The color of the detector membrane was noted at the seventh breath following intubation. The color also was noted and recorded if there was return of spontaneous circulation (defined as a palpable pulse) immediately prior to and following conversion from manual to mechanical CPR. Survival to hospital admission was used as an end point to assess the prognostic value of the initial ETCO2 reading. Main results: A total of 227 patients (144 with cardiopulmonary arrest) were studied. In the 83 patients intubated but not in cardiopulmonary arrest, a reading on the ETCO2 detector signifying more than 0.5% ETCO2 was 100% sensitive and 93% specific in detecting proper endotracheal tube placement (100% specific with the endotracheal tube cuff inflated). In cardiac arrest patients, a longer period of estimated arrest appeared to be associated with a lower ETCO2 detector reading. A reading signifying more than 0.5% ETCO2 was 69% sensitive and 100% specific in detecting proper endotracheal tube placement. After proper endotracheal tube placement, all cardiac arrest patients who survived to hospital admission had an initial ETCO2 measurement signifying more than 0.5% ETCO2. Return of spontaneous circulation was usually accompanied by an improved ETCO2 value. Mechanical CPR always produced an ETCO2 value that was as high or higher than that produced by manual CPR. Conclusion: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg, esophageal intubation, inadequate circulatory flow, prolonged downtime interval, hypothermia, or significant ventilation/perfusion mismatch).

Original languageEnglish (US)
Pages (from-to)518-523
Number of pages6
JournalAnnals of Emergency Medicine
Volume21
Issue number5
DOIs
StatePublished - 1992

Fingerprint

Carbon Dioxide
Multicenter Studies
Heart Arrest
Hand
Equipment and Supplies
Cardiopulmonary Resuscitation
Reading
Intubation
Color
Hypothermia
Resuscitation
Respiratory Insufficiency
Ventilation
Hospital Emergency Service
Emergencies
Perfusion
Physicians
Membranes
Survival

Keywords

  • end-tidal CO detection

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Ornato, J. P., Shipley, J. B., Racht, E. M., Slovis, C. M., Wrenn, K. D., Pepe, P. E., ... Fotre, T. V. (1992). Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Annals of Emergency Medicine, 21(5), 518-523. https://doi.org/10.1016/S0196-0644(05)82517-X

Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. / Ornato, Joseph P.; Shipley, Joshua B.; Racht, Edward M.; Slovis, Corey M.; Wrenn, Keith D.; Pepe, Paul E.; Almeida, Sherri Lyne; Ginger, Vicki F.; Fotre, Terry V.

In: Annals of Emergency Medicine, Vol. 21, No. 5, 1992, p. 518-523.

Research output: Contribution to journalArticle

Ornato, JP, Shipley, JB, Racht, EM, Slovis, CM, Wrenn, KD, Pepe, PE, Almeida, SL, Ginger, VF & Fotre, TV 1992, 'Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device', Annals of Emergency Medicine, vol. 21, no. 5, pp. 518-523. https://doi.org/10.1016/S0196-0644(05)82517-X
Ornato, Joseph P. ; Shipley, Joshua B. ; Racht, Edward M. ; Slovis, Corey M. ; Wrenn, Keith D. ; Pepe, Paul E. ; Almeida, Sherri Lyne ; Ginger, Vicki F. ; Fotre, Terry V. / Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. In: Annals of Emergency Medicine. 1992 ; Vol. 21, No. 5. pp. 518-523.
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AU - Wrenn, Keith D.

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AU - Almeida, Sherri Lyne

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N2 - Study objectives: To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. Type of participants: Adult patients were included if an endotracheal tube was inserted by prehospital care providers or emergency physicians for cardiac arrest, respiratory arrest, respiratory insufficiency, or airway protection. Design and interventions: A small, portable, colorimetric ETCO2 detector was attached to the endotracheal tube immediately after each attempted endotracheal tube insertion. The color of the detector membrane was noted at the seventh breath following intubation. The color also was noted and recorded if there was return of spontaneous circulation (defined as a palpable pulse) immediately prior to and following conversion from manual to mechanical CPR. Survival to hospital admission was used as an end point to assess the prognostic value of the initial ETCO2 reading. Main results: A total of 227 patients (144 with cardiopulmonary arrest) were studied. In the 83 patients intubated but not in cardiopulmonary arrest, a reading on the ETCO2 detector signifying more than 0.5% ETCO2 was 100% sensitive and 93% specific in detecting proper endotracheal tube placement (100% specific with the endotracheal tube cuff inflated). In cardiac arrest patients, a longer period of estimated arrest appeared to be associated with a lower ETCO2 detector reading. A reading signifying more than 0.5% ETCO2 was 69% sensitive and 100% specific in detecting proper endotracheal tube placement. After proper endotracheal tube placement, all cardiac arrest patients who survived to hospital admission had an initial ETCO2 measurement signifying more than 0.5% ETCO2. Return of spontaneous circulation was usually accompanied by an improved ETCO2 value. Mechanical CPR always produced an ETCO2 value that was as high or higher than that produced by manual CPR. Conclusion: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg, esophageal intubation, inadequate circulatory flow, prolonged downtime interval, hypothermia, or significant ventilation/perfusion mismatch).

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