EVALUATION OF AN END-TIDAL CO2 DETECTOR DURING PEDIATRIC CARDIOPULMONARY-RESUSCITATION

Objective. To determine the utility of a disposable colorimetric end-t idal CO2 detector during pediatric cardiopulmonary resuscitation (CPR) for (1) confirming endotracheal tube (ETT) position, and (2) assessin g the relationship between end-tidal CO2 recorded by this method and o utcome of pediatric CPR. Design/setting. Prospective observations duri ng CPR in a university children's hospital. Participants. Forty childr en (28 male, 12 female) aged 1 week to 10 years (25 children aged less than or equal to 1 year, mean age 27.2 months, median 7 months), weig hing 2.5 to 40 kg (31 children weighing less than or equal to 15 kg, m ean 10.94 kg, median 7 kg) who underwent a total of 48 endotracheal in tubations during CPR. Methods. After intubation, ETT position was veri fied by usual clinical methods including direct visualization. The dev ice was attached between the ETT and ventilation bag, the patient was manually ventilated, and a first reading was obtained. Any color chang e from purple (Area A, end-tidal CO2 < 0.5%) to tan or yellow (Area B or C, end-tidal CO2 greater than or equal to 0.5%) was considered to b e positive for airway intubation. CPR was conducted as per Pediatric A dvanced Life Support guidelines. A second reading was obtained when th e decision to discontinue CPR was made. Results. All nine esophageal t ube positions were correctly identified by the detector. Thirty-three of 39 tracheal tube positions were correctly identified (P <.001). For verifying ETT position, the device had a sensitivity of 84.6%, specif icity of 100%, positive predictive value of 100%, and negative predict ive value of 60%. Readings were obtained at the end of CPR in 25 patie nts. All 13 patients who regained spontaneous circulation and survived to ICU admission had a second reading in the C range, while none of t he 12 patients with a second reading in the A or B range survived. Bot h the first and second end-tidal CO2 readings in the C range correlate d significantly with short-term survival (P =.01 and P <.001, respecti vely). Two patients were eventually discharged from the hospital. Conc lusions. During CPR a positive test confirms placement of the ETT with in the airway, whereas a negative test indicates either esophageal int ubation or airway intubation with poor or absent pulmonary blood flow and requires an alternate means of confirmation of tube position. The detector may be of prognostic value for return of spontaneous circulat ion and short-term survival.