Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians

Emerg Med J. 2005 Jul;22(7):490-3. doi: 10.1136/emj.2004.015818.


Objectives: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Capnography / methods
  • Capnography / statistics & numerical data*
  • Colorimetry / statistics & numerical data
  • Emergency Service, Hospital / standards*
  • Health Care Surveys
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods*
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data
  • United States