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

Details

• Personal Author:
  Carte E ; Falk J ; Krauss B ; Ralls GA ; Rothrock SG ; Senn A ; Silvestri S ; Thundiyil J ; Carte E ; Falk J ; Krauss B ; Ralls GA ; Rothrock SG ; Senn A ; Silvestri S ; Thundiyil J
• Description:
  STUDY OBJECTIVE: We evaluate the association between out-of-hospital use of continuous end-tidal carbon dioxide (ETCO2) monitoring and unrecognized misplaced intubations within a regional emergency medical services (EMS) system. METHODS: This was a prospective, observational study, conducted during a 10-month period, on all patients arriving at a regional Level I trauma center emergency department who underwent out-of-hospital endotracheal intubation. The regional EMS system that serves the trauma service area is composed of multiple countywide systems containing numerous EMS agencies. Some of the EMS agencies had independently implemented continuous ETCO2 monitoring before the start of the study. The main outcome measure was the unrecognized misplaced intubation rate with and without use of continuous ETCO2 monitoring. RESULTS: Two hundred forty-eight patients received out-of-hospital airway management, of whom 153 received intubation. Of the 153 patients, 93 (61%) had continuous ETCO2 monitoring, and 60 (39%) did not. Forty-nine (32%) were medical patients, 104 (68%) were trauma patients, and 51 (33%) were in cardiac arrest. The overall incidence of unrecognized misplaced intubations was 9%. The rate of unrecognized misplaced intubations in the group for whom continuous ETCO2 monitoring was used was zero, and the rate in the group for whom continuous ETCO2 monitoring was not used was 23.3% (95% confidence interval 13.4% to 36.0%). CONCLUSION: No unrecognized misplaced intubations were found in patients for whom paramedics used continuous ETCO2 monitoring. Failure to use continuous ETCO2 monitoring was associated with a 23% unrecognized misplaced intubation rate. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Health Care Facilities Workforce And Services Health Personnel Occupational Health Safety Surveys And Questionnaires Workplace
• Keywords:
  Biological-effects Emergency-care Emergency-responders Emergency-treatment Health-care-facilities Health-care-personnel Medical-examinations Medical-facilities Medical-monitoring Medical-personnel Medical-rescue-services Medical-services Medical-surveys Medical-treatment Physiological-effects Physiological-measurements Physiological-response Statistical-analysis Work-environment Work-practices

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• ISSN:
  0196-0644
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  California ; Florida ; Massachusetts ; OSHA Region 1 ; OSHA Region 4 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Pages in Document:
  497-503
• Volume:
  45
• Issue:
  5
• NIOSHTIC Number:
  nn:20037229
• Citation:
  Ann Emerg Med 2005 May; 45(5):497-503
• Contact Point Address:
  Salvatore Silvestri, MD, Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL
• Email:
  ems.medicaldirector@ocfl.net
• CAS Registry Number:
  Carbon dioxide (CAS RN 124-38-9) ; Carbon dioxide (CAS RN 124-38-9)
• Federal Fiscal Year:
  2005
• Performing Organization:
  University of California, Berkeley
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  Annals of Emergency Medicine
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fcebe3af3036ed318b4ad638d959f001588e71879d9264deb4b687eb004ece03520075afa121c16b7409455cdb53fa580fe7425c0d9a40a8f84a543382992f89
• Download URL:
  https://stacks.cdc.gov/view/cdc/188357/cdc_188357_DS1.pdf
• File Type:
  [PDF - 122.50 KB ]