MERGINET.com: June 2005, MERGINET—In a long-awaited paper, Sal Silvestri, MD, and colleagues in Orlando, Florida, give US additional information on continuous waveform capnography. June 2005, MERGINET—In a long-awaited paper, Sal Silvestri, MD, and colleagues in Orlando, Florida, give US additional information on continuous waveform capnography.

In this prospective 10-month study, 248 patients received out-of-hospital airway management and 153 were intubated in the field. Interestingly, of the 153 patients intubated, 93 (61 percent) had continuous waveform capnography while 60 (39 percent) did not. Of these, 104 (68 percent) were trauma patients, 49 (32 percent) were medical patients and 51 (33 percent) were in cardiac arrest. The overall incidence of unrecognized esophageal intubation (UEI) was 9 percent, which is quite similar to the rate seen in other studies. However, when continuous waveform capnography was used the incidence of UEI was zero. The UEI incidence was 23.3 percent for the group that failed to receive end-tidal carbon dioxide monitoring. Interestingly, Steve Katz, MD performed a study several years ago in Orange County, Florida, and found an UEI of 25 percent. This was considered somewhat of a fluke finding—but Silvestri has reproduced that here.

  

This is convincing evidence that continuous waveform capnography improves (and in this study eliminates) the rate of UEI. From a systems standpoint, I hope they are looking at why paramedics in the greater Orlando area have a UEI rate of 23.3 percent when capnography was not used. I agree that waveform capnography is a de facto standard of care. However, simply applying technology does little to correct the overall problem with poor endotracheal intubation success in at least a portion of Orlando-area paramedics.

By Bryan E. Bledsoe, DO, FACEP, from www.merginet.com

References

Silvestri S, Ralis GA, Krauss B, et al. “The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system.” Annals of Emergency Medicine. 2005;45(5)497-503.

 

Katz SH, Falk JL. “Misplaced endotracheal tubes by paramedics in an urban emergency medical services system.” Annals of Emergency Medicine. 2001;37(1):32-7.

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