Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-11T17:21:21.360Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of a Colorimetric End-Tidal CO2 Detector and an Esophageal Aspiration Device for Verifying Endotracheal Tube Placement in the Prehospital Setting: A Six-Month Experience

Published online by Cambridge University Press:  28 June 2012

Richard J. Schaller ,
J. Stephen Huff  and
Allan Zahn
Richard J. Schaller*
Affiliation:
Chief Resident, Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
J. Stephen Huff
Affiliation:
Eastern Virginia Medical School, Norfolk, Virginia, USA
Allan Zahn
Affiliation:
Resident, Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
*
244 Oak Lane Tabernacle, NJ 08088USA Telephone (609) 859-1638
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Hand held, colorimetric, end-tidal CO2 detector devices are being used to verify correct endotracheal tube (ETT) placement. The accuracy of these devices has been questioned in situations of cardiac arrest. The use of the esophageal detector device (EDD) is an easy alternative for detection of ETT placement, and may be more accurate in situations of cardiac arrest.

Hypothesis:

The use of the esophageal aspiration device in comparison with a colorimetric end-tidal CO2 detector is more accurate in detecting proper ETT placement and easier to use in the prehospital setting than is the colorimetric end-tidal CO2 detection device.

Methods:

This was a prospective alternating weeks, 6-month study in a prehospital setting. Participants included all patients older than 18 years who were intubated by the Portsmouth, Virginia Emergency Medical Services (EMS) personnel from 01 July 1993 through 31 December 1993. The aspiration device used, also known as an esophageal detector device (EDD), was a 60 ml, luer-lock syringe attached to a 15 mm ETT adapter. Its efficacy was compared with an already accepted method of ETT position detection, the colorimetric endtidal CO2 detector. Each device was used on alternating weeks, and correct ETT placement was determined by the receiving emergency department physician using standard techniques. Chi-square analysis and Fisher's Exact test were used to compare parameters, time of device use, and ease of use. Sensitivity and specificity were calculated, and provider preference was assessed using a survey instrument administered following completion of the study.

Results:

There were 49 patients who met the inclusion criteria, but six were excluded because of situational circumstances rendering use of the device a possible compromise of patient care. Twenty-five patients were in the EDD group, and 18 were in the endtidal CO2 detector group. There was no statistically significant difference detected between groups for the gender ratio, underlying condition, CPR in progress, perceived difficulty of intubation, or percentage of nasotracheal intubation. The EDD was significantly easier to use (p<0.005). There was no statistically significant difference in time required for use of end-tidal CO2 detector device versus the EDD. The sensitivity and specificity for correct tracheal placement using the EDD was 100%, and the sensitivity for correct tracheal placement using the end-tidal CO2 detector device was 78%. Use of the EDD was preferred over use of the end-tidal CO2 detector device by 75% of participating EMS providers. One case of nasotracheal intubation with an ETT placement above the cords raised the question of accuracy of this device in situations where direct visualization is not utilized.

Conclusion:

The EDD was accurate in all cases of orotracheal intubation, and was easier to use than was end-tidal CO2 detector device. It was preferred by 75% of participating EMS providers. In cases in which the ETT may be above the vocal cords, caution must be used with interpreting the results obtained by use of the EDD.

Keywords

capnographycolorimetric end-tidal CO2 detectorEDDendotracheal intubation, endotracheal tube, esophageal detector deviceesophageal intubationprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 12 , Issue 1 , March 1997 , pp. 57 - 63
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Birmingham, P, Cheney, F, Ward, R: Esophageal intubation: A review of detection techniques. Anesth Analg 1986;65:886–891.CrossRefGoogle ScholarPubMed
2. Pollard, BJ, Junius, F: Accidental intubation of the oesophagus. Anaesth Intensive Care 1980;8:183–186.CrossRefGoogle ScholarPubMed
3. Howells, TH, Riethmuller, RJ: Signs of endotracheal intubation. Anaesthesia 1980;35:984–986.CrossRefGoogle ScholarPubMed
4. Ornato, JP, Garnett, AR, Glauser, FL. Relationship between cardiac out-put and the end-tidal carbon dioxide tension. Ann Emerg Med 1990;19:1104–1106.CrossRefGoogle Scholar
5. Wee, MYK: The oesophageal detector device: Assessment of a new method to distinguish oesophageal from tracheal intubation. Anaesthesia 1988;43:27–29.CrossRefGoogle ScholarPubMed
6. Linko, K, Paloheimo, M, Tassisto, T: Capnography for detection of accidental oesphageal intubation. Acta Anaesth Scand 1983;27:199–202.CrossRefGoogle Scholar
7. Goldberg, JS, Rawle, PR, Qehnder, JL et al. : Colorimetric end-tidal carbon dioxide monitoring for tracheal intubation. Anesth Analg 1990;70:191–194.CrossRefGoogle ScholarPubMed
8. Anton, W, Gordon, R, Jordan, T et al. : A disposable end-tidal CO2 detector to verify endotracheal intubation. Ann Emerg Med 1991;20:3:271–275.CrossRefGoogle ScholarPubMed
9. MacLeod, B, Heller, M, Gerard, J et al. : Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection. Ann Med 1991;20:3:267–270.CrossRefGoogle ScholarPubMed
10. Ornato, JP, Shipley, J, Racht, E et al. : Multicenter Study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med 1992;21:518–523.CrossRefGoogle ScholarPubMed
11. O'Leary, JJ, Pollard, BJ, Ryan, MJ: A method of detecting oesophageal intubation or confirming tracheal intubation. Anaesth Intensive Care 1988;16:299–301.CrossRefGoogle ScholarPubMed
12. Williams, KN, Nunn, JF: The oesophageal detector device: A prospective trial on 100 patients. Anaesthesia 1989;44:412–414.CrossRefGoogle ScholarPubMed
13. Oberly, D, Stein, S, Hess, D et al. : An evaluation of the esophageal detector device using a cadaver model. Amer J Emerg Med 1992;10:317–320.CrossRefGoogle ScholarPubMed
14. Foutch, R, Magelssen, M, MacMillan, J: The esophageal detector device: A rapid and accurate method for assessing tracheal versus esophageal intubation in a porcine model. Ann Emerg Med 1992;21:1073–1076.CrossRefGoogle ScholarPubMed
15. Zaleski, L, Abello, D, Gold, M: The esophageal detector device. Anesthesiology 1993;79:244–247.CrossRefGoogle ScholarPubMed
16. Baraka, A, Choueiry, P, Salem, R: The esophageal detector device in morbidly obese. Anesth Analg 1993;77:400. Letter.Google ScholarPubMed
17. Donahue, PL: The oesophageal detector device. An assessment of accuracy and ease of use by paramedics. Anaesthesia 1994;49:863–865.CrossRefGoogle ScholarPubMed