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

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.