Electronic End Tidal CO2 (ETCO2) Monitors—Capnography
Capnography or capnometry is considered the “gold standard” of tube placement confirmation. Waveform ETCO2 is the preferred confirmation device. These devices measure the amount of carbon dioxide in the exhaled ventilations of patients. They can use mainstream sensors, which are located directly on the endotracheal tube, or sidestream sensors, which sample the ventilation more remotely. Capnography can also be used with patients who are not intubated. In-line EtCO2 monitors can be used on patients with or without adequate perfusion. Electronic monitors show changes in real-time.
If this equipment is available, it should be used on EVERY intubation, and always be one of the five confirmation steps. Ventilations should be titrated to ETCO2 of 35-45 mm/Hg. To increase CO2, slow down ventilations, and to decrease CO2, speed up ventilations. MAINTAIN THIS DEVICE UNTIL PATIENT CARE IS TRANSFERRED TO THE RECEIVING HOSPITAL STAFF.
For any department whose monitors have summary capabilities, that summary must be presented with the patient.
Patients in asystole with a confirmed correct tube placement and a capnography reading < 10 mm/Hg, which does not improve during resuscitative efforts, have essentially no probability of survival and field termination should be strongly considered.