Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.
OBJECTIVE
To determine the availability of end-tidal CO2 measurement in confirmation of endotracheal tube placement in the non-arrest patient, and to assess its use in academic and non-academic emergency departments.


METHODS
Emergency physicians in the USA were surveyed by mail in the beginning of the year 2000 regarding availability at their institution of both colorimetric/qualitative and quantitative end-tidal CO2 capnography, frequency of use in their own practice, and descriptor of their hospital (academic, community teaching, and community non-teaching). Additionally, data were obtained from the National Emergency Airway Registry 97 series (NEAR) about how many intubations used this method of confirmation. NEAR site coordinators were surveyed as well.


RESULTS
Of 1000 surveys, 550 were returned (55%). Colorimetric technology existed in 77% of respondents' hospitals (n = 421); 25% of respondents (n = 138) had continuous monitoring capability. Physicians practising at academic hospitals were more likely to have continuous monitoring (36%; n = 196) than community teaching institutions (32%; n = 173) and non-teaching centres (18%; n = 100) (p<0.001). Among physicians who had this technology available, only 14% (n = 19) "always" used it in non-arrest intubations; 57% "rarely" or "never" employed it (n = 75). Among NEAR centres (institutions committed to monitoring current airway practices) only 12% of 6009 (n = 716) intubations used continuous end-tidal CO2 measurement. Of these practitioners, only 40% "always" used it (n = 6/15) (83% response rate (n = 29/35)).


CONCLUSIONS
Despite recommendations from national organisations that endorse continuous monitoring of end-tidal CO2 for confirming endotracheal tube placement, it is neither widely available nor consistently applied.
Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. deiorion@ohsu.edu
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D019296:Capnography / Q000379:methods / Q000706:statistics & numerical data*; D003124:Colorimetry / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States