Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device

Part 8: Adult Advanced Cardiovascular Life Support

“…In addition, elimination and detection of CO 2 can be drastically reduced with severe airway obstruction (eg, status asthmaticus) and pulmonary edema. 93,97,98 For these reasons, if CO 2 is not detected, we recommend that a second method be used to confirm endotracheal tube placement, such as direct visualization or the esophageal detector device.…”

Part 14: Pediatric Advanced Life Support

“…115,116 Remember that a color change or the presence of a capnography waveform confirms tube position in the airway but does not rule out right mainstem bronchus intubation. During cardiac arrest, if exhaled CO 2 is not detected, confirm tube position with direct laryngoscopy (Class IIa, LOE C) 110,[117][118][119][120] because the absence of CO 2 may reflect very low pulmonary blood flow rather than tube misplacement.…”

Part 8: Advanced Life Support

“…Studies of colorimetric end-tidal CO 2 (ETCO 2 ) detectors (LOE D2 135,136 ; LOE D4 [137][138][139] ; LOE D5 140,141 ), the syringe aspiration esophageal detector device (LOE D1 133 ; LOE D4 142 ), the self-inflating bulb esophageal detector device (LOE D1), [132][133][134] and nonwaveform end-tidal CO 2 capnometers (LOE D2 130,143 ; LOE D4 137 ; LOE D5 141 ) showed that the accuracy of these devices is similar to the accuracy of clinical assessment (not uniformly defined across all studies) for confirming the tracheal position of a tracheal tube in victims of cardiac arrest.…”

“…Eleven studies showed that physiological monitoring values (ETCO 2 , coronary perfusion pressure, venous oxygen saturation) increased when ROSC was achieved (LOE 4) [171][172][173][174][175][176][177][178]135,179,180 and that they may be an indication of ROSC before it can be seen in vital signs. 181 Five of the studies found that ETCO 2 was accurate for predicting patients who could not be resuscitated; some gave a time frame for that prediction of 20 minutes (LOE 4).…”