References

Abramo TJ, Wiebe RA, Scott S Noninvasive capnometry monitoring for respiratory status during pediatric seizures. Crit Care Med. 1997; 25:(7)1242-6

Agus MSD, Alexander JL, Mantell PA Continuous noninvasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosis. Pediatr Diabetes. 2006; 7:(4)196-200

Ahrens T, Schallom L, Bettorf K End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001; 10:(6)391-8

Ahrens T, Sona C Capnography application in acute and critical care. AACN Clinical Issues. 2003; 14:(2)123-32

Bhende MS, Lacovey D End-tidal carbon dioxide monitoring in the prehospital setting. Prehosp Emerg Care. 2001; 5:(2)208-13

British guideline on the management of asthma. Thorax. 2003; 58:(Suppl 1)

Cantineau JP, Lambert Y, Merckx P End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: A predictor of outcome. Critical Care Medicine. 1996; 24:(5)791-6

Corbo J, Bijur P, Lahn M Concordance between capnography and arterial blood gas measurements of carbon dioxide in acute asthma. Ann Emerg Med. 2005; 46:(4)323-7

Davis DP, Hoyt DB, Ochs M The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma. 2003; 54:(3)444-53

Davis DP, Dunford JV, Poste JC The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of patients with severe traumatic brain injury. J Trauma. 2004; 57:(1)1-10

Deakin CD, Sado DM, Coats TJ Prehospital end-tidal carbon dioxide concentration and outcome in major trauma. J Trauma. 2004; 57:(1)65-8

Delorio NM Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians. Emerg Med J. 2005; 22:(7)490-3

Deitch K, Miner J, Chudnofsky CR Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Ann Emerg Med. 2010; 55:(3)258-64

Department of Health. 2010. http//tinyurl.com/2a8ljeo (accessed 03/03/2001)

Donald MJ, Paterson B End-tidal carbon dioxide monitoring in prehospital and retrieval medicine: a review. EMJ. 2006; 23:(9)728-30

Falk JL, Sayne MP Confirmation of airway placement. Prehosp Emerg Care. 1999; 3:273-8

Fearon DM, Steele DW End-tidal carbon dioxide predicts the presence and severity of acidosis in children with diabetes. Acad Emerg Med. 2002; 9:(12)1373-8

Gilboy N, Hawkins M Noninvasive monitoring of end-tidal carbon dioxide in the emergency department. Advanced Emergency Nursing Journal. 2006; 28:(4)301-13

Grant ISEdinburgh2011

Gravenstein JS, Paulus DA, Hayes TJStoneham, MA: Butterworth; 1989

Grmec S, Klemen P Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?. Eur J Emerg Med. 2001; 8:(4)263-9

Grmec S, Malley S Prehospital determination of tracheal tube placement in severe head injury. Emerg Med J. 2004; 21:(4)518-20

Grmec S, Križmari M, Mally S Utstein style analysis of out-of-hospital cardiac arrest-Bystander CPR and end expired carbon dioxide. Resuscitation. 2007; 72:(3)404-14

Gudipati CV, Weil MH, Bisera J Expired carbon dioxide: a non-invasive monitor of cardiopulmonary resuscitation. Circulation. 1988; 77:(1)234-9

Helm M, Hauke J, Lampl L About the quality of prehospital emergency ventilation: a prospective study in patients with severe head injury. Br JAnaesth. 2002; 88:(3)345-59

Helm M, Fischer S The role of capnography in prehospital ventilation for trauma patients. Int Journ Int Care. 2005; 12:(3)124-30

Advanced Life Support Resuscitation. 2005; 67:(2-3)213-7

Jabre P, Jacob L, Auger H Capnography monitoring in nonintubated patients with respiratory distress. Am J Emerg Med. 2009; 27:(9)1056-9

Kalenda Z The capnogram as a guide to the efficacy of cardiac massage. Resuscitation. 1978; 6:(4)259-63

Kartal M, Goksu E, Eray O The value of ETCO2 measurement for COPD patients in the emergency department. Eur J Emerg Med. 2010; 13:(7)

Kasuya Y, Akça O, Sessler DI Accuracy of postoperative end-tidal Pco2 measurements with mainstream and sidestream capnography in non-obese patients and in obese patients with and without obstructive sleep apnea. Anesthesiology. 2009; 111:(3)609-15

Kim DH, Shim JK, Choi YS Distinct capnographic waveform in a pulmonary embolism caused by intravenous leiomyomatosis. Anaesthesia. 2009; 64:(4)453-5

Krauss BS, Deykin A, Lam A Capnogram shape in obstructive lung disease. Anesthesia Analg. 2005; 100:(3)884-8

Lah K, Grmec S The role of end-tidal carbon dioxide monitoring in rapid sequence intubation. Journal of Paramedic Practice. 2010; 2:(11)518-23

Law GT, Wong CY, Kwan CW Concordance between sidestream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting. Hong Kong Med J. 2009; 15:(6)440-6

Langhan M, Chen L Current utilization of continuous end-tidal carbon dioxide monitoring in pediatric emergency departments. Pediatric Emergency Care. 2008; 24:(4)211-3

Levine RL, Wayne MA, Miller CL End-tidal carbon dioxide and outcome of out of hospital cardiac arrest. NEJM. 1997; 337:(5)301-6

Li J Capnography alone is imperfect for endotracheal intubation during emergency intubation. J Emerg Med. 2001; 20:(3)223-9

Lockey D, Davies G Survival of trauma patients who have prehospital intubation without anaesthesia or muscle relaxants: observational study. BMJ. 2001; 323:141-5

Lovett PB The vexatious vital: Neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med. 2005; 45:(1)68-76

McGillicuddy DC, Tang A, Cataldo L Evaluation of end-tidal carbon dioxide role in predicting elevated SOFA scores and lactic acidosis. Intern Emerg Med. 2009; 4:(1)

Miner JR, Heegard W, Plummer D End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med. 2002; 9:(4)275-80

Chronic obstructive pulmonary disease: national clinical guideline for management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004; 59:(Suppl 1)

Ochoa FJ The effect of rescuer fatigue on the quality of chest compressions. Resuscitation. 1998; 37:(3)149-52

Omert L, Woodrow Y, Mizikowski S Role of emergency medicine physician in airway management of the trauma patient. J Trauma. 2001; 51:1065-8

Palmon SC, Liu M, Moore LE Capnography facilitates tight control of ventilation during transport. Crit Care Med. 1996; 24:(4)608-11

Pokorna M J Emerg Med. 2010; 38:(5)614-21

Redford DT, Barker SJ, Lichtenthal PR Evaluation of 2 forehead reflectance oximeters in intraoperative surgical patients. Anesth Analg. 2004; 98:(3)

Richardson WS, Wilson MC The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995; 123:(3)12-3

Sakata DJ, Matsubara I, Gopalakrishnan NA Flow-through versus sidestream capnometry for detection of end tidal carbon dioxide in the sedated patient. J Clin Monit Comput. 2009; 23:(2)115-22

Salen P, O'Connor R, Sierzenski P Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes?. Acad Emerg Med. 2001; 8:(6)610-5

Santos LJ, Varon J, Pic-Aluas L Practical uses of end-tidal carbon dioxide monitoring in the emergency department. J Emerg Med. 1994; 12:(5)633-44

Schardt C, Adams MB, Owens T Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007; 7

Stein PD, Fowler SE, Goodman LR PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006; 354:2317-27

Tyburski JG, Carlin AM, Harvey EHS End-tidal CO2-arterail CO2 difference: a useful intraoperative mortality marker in trauma surgery. J Trauma. 2003; 55:892-7

UK Resusitation Council. 2010. http//tinyurl.com/72c2aa5 (accessed 7 December 2011)

Warner KJ, Cuschieri J, Garland B The utility of early end-tidal capnography in monitoring ventilation status after severe injury. The Journal of Traum. 2009; 66:(1)26-31

Zwerneman K End-tidal carbon dioxide monitoring: A vital sign worth watching. Critical Care Nursing Clinics of North America. 2006; 18:(2)217-25

Potential applications of capnography in the prehospital setting

12 January 2012
Volume 4 · Issue 1

Abstract

End-tidal carbon dioxide (ETCO2) monitoring is well established in hospital theatre and critical care settings (Lah and Grmec, 2010), employed for observation and monitoring in anaesthesia. Its application has now extended to the prehospital environment, primarily for the verification of endotracheal tube (ETT) placement, endeavouring to reduce the occurrence of oesophageal intubations (Grmec and Malley, 2004). In recent times, technological advances, coupled with an increased appreciation of the importance of prehospital interventions, has resulted in the production of additional equipment capable of monitoring ETCO2 in non-intubated, self-ventilating patients via a non-invasive nasal cannula. Despite having an extensive range of potential uses, the apparatus is widely underused (Langhan and Chen, 2008). In this article, potential applications in the prehospital setting will be discussed via a review of contemporary literature.

In the late 1970s, capnography was developed as a monitoring tool for use during anaesthesia and intensive care following extensive work by Smallhout and Kalenda highlighting its benefits (Gravenstein et al, 1989). Its use spread over time to emergency departments and prehospital care as an adjunct to verify intubation success (Donald and Paterson, 2006).

A non-invasive technique, prehospital capnography measures exhaled carbon dioxide through a ‘sidestream’ capnometer; a preset volume of gas is aspirated from the patients expired breath and pumped from an adaptor (positioned on an endotracheal tube or near the patient's airway) to a monitor for analysis (Gilboy and Hawkins, 2006), and accordingly produces a capnogram waveform of expired carbon dioxide against time (Figure 1) (Zwerneman, 2006). Table 1 illustrates some commonly used terms in the study of capnography (Bhende and LaCovey, 2001).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed