title: Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom.
abstract: BACKGROUND
  Airway complications occur more frequently outside the operating theatre and in emergency situations. Capnography remains the gold standard for confirming correct endotracheal tube placement, retaining high sensitivity and specificity in cardiac arrest. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting. We investigated current UK practice relating to the availability and use of this technology during cardiac arrest.
  
  
  METHODS
  Between June and November 2014, a study was conducted of all UK acute hospitals with both a level three adult intensive care unit (ICU) and an emergency department (ED). A telephone questionnaire was administered examining intubation practice and utilisation of capnography within the ED, ICU and general wards.
  
  
  RESULTS
  Two hundred and eleven hospitals met the inclusion criteria. The response rate was 100%. Arrests were mainly attended by anaesthesia (48%) and ICU physicians (38%) of registrar grade (56%). The ability to measure end tidal carbon dioxide (ETCO2) was available in all but 4 EDs; most used in waveform devices. Most ICUs were similar. However, in 67% of hospitals surveyed, it was not possible to measure ETCO2 in general wards. Where available, 87% used capnography to confirm ETT placement with less than 50% using ETCO2 to determine CPR effectiveness and 8% to prognosticate.
  
  
  CONCLUSIONS
  We believe this is the first study of its kind to fully investigate the availability and use of capnography during cardiac arrest throughout the hospital. Whilst equipment provision appears adequate in critical care areas, it is insufficient in general wards.
authors.affiliation: North Central London School of Anaesthesia, Royal Free Hospital, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Turle
authors.affiliation: Barts and the London School of Anaesthesia, Royal London Hospital, London, United Kingdom.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Sherren
authors.affiliation: North Central London School of Anaesthesia, Royal Free Hospital, London, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Nicholson
authors.affiliation: North Central London School of Anaesthesia, Royal Free Hospital, London, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Callaghan
authors.affiliation: Barts and the London School of Anaesthesia, Royal London Hospital, London, United Kingdom. Electronic address: sj.shepherd@nhs.net.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Shepherd
mesh_terms: D000328:Adult; D019296:Capnography / Q000706:statistics & numerical data*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004630:Emergencies; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D012189:Retrospective Studies; D006113:United Kingdom
keywords: Capnography; Cardiopulmonary resuscitation; Intubation