• Ann Emerg Med · Mar 1991

    Verification of endotracheal tube placement with colorimetric end-tidal CO2 detection.

    • B A MacLeod, M B Heller, J Gerard, D M Yealy, and J J Menegazzi.
    • Affiliated Residency in Emergency Medicine, University of Pittsburgh, Pennsylvania.
    • Ann Emerg Med. 1991 Mar 1;20(3):267-70.

    Study ObjectiveTo determine the ability of a disposable colorimetric CO2 detector to accurately confirm or refute endotracheal tube placement.DesignTwo hundred fifty prospective emergency intubations.SettingEmergency intubations performed in the emergency department, helicopter, and prehospital ground environment.Type Of ParticipantsIntubations were performed by emergency medicine residents, paramedics, and flight nurses.InterventionsThe FEF CO2 detector was applied after 250 emergency intubations. Notation of color change indicating intratracheal placement was recorded in each case. Confirmation of refutation of the detector's results was determined subsequently through traditional methods.ResultsThe sensitivity for confirmation of endotracheal intubation in the 137 patients with a palpable pulse was 100%. However, only 76 of 103 patients (sensitivity, 72%) in cardiac arrest had endotracheal intubation confirmed by color change. The device was uniformly specific for tracheal intubation in 73 arrested patients in whom a color change was noted (100%). There was one instance (of a total of seven misintubations) in which a positive color change was noted, but the tube was not intratracheal (specificity, 86%). Overall sensitivity for tracheal intubation was 88% (95% confidence limits; range, 0.83 to 0.92), and specificity for tracheal intubation was 92% (95% confidence limits; range, 0.62 to 0.99).ConclusionThe FEF colorimetric detector reliably detects intratracheal placement in the nonarrested patient. Its use in prolonged cardiac arrest merits further study.

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