Hayden S R, Sciammarella J, Viccellio P, Thode H, Delagi R
Department of Emergency Medicine, University of California, San Diego, USA.
Acad Emerg Med. 1995 Jun;2(6):499-502. doi: 10.1111/j.1553-2712.1995.tb03247.x.
To evaluate the ability of a disposable, colorimetric end-tidal CO2 detector to verify proper endotracheal (ET) tube placement in out-of-hospital cardiac arrest, and to correlate semiquantitative CO2 measurements with the rate of return of spontaneous circulation (ROSC).
Prospective, observational study using a convenience sample of intubated out-of-hospital cardiac arrest patients. A disposable, colorimetric end-tidal CO2 detector was attached to the ET tube after intubation. In the absence of a colorimetric change, the paramedics reassessed the tube placement and could reintubate the patient. Tube placement was verified at the hospital. Paramedics were instructed to contact the base station and report the colorimetric change upon hospital arrival. ROSC was defined as restoration of a self-sustaining pulse until hospital arrival.
Between December 1990 and May 1993, ET tubes were placed in 566 victims of out-of-hospital cardiac arrest. 541 of the 566 intubations (95.6%) were associated with a color change. In one case with a color change and out-of-hospital clinical evidence of proper tube placement, the tube was determined to be in the esophagus at the hospital. Correct placement of the remaining 565 of 566 (99.8%) tubes was verified. Of the 566 patients who had a colorimetric change, 91 (16%) had ROSC vs one of 25 (4%) patients who did not have a color change. In one subgroup (n = 179), the degree of color change was highly associated with ROSC (p = 0.004).
A disposable, colorimetric end-tidal CO2 detector appears reliable in verifying proper ET tube placement in victims of out-of-hospital cardiac arrest. The degree of color change correlates with the probability of ROSC.
评估一种一次性比色呼气末二氧化碳检测仪在院外心脏骤停时验证气管内（ET）导管正确放置的能力，并将半定量二氧化碳测量值与自主循环恢复（ROSC）率相关联。
采用前瞻性观察研究，对院外心脏骤停插管患者进行便利抽样。插管后将一次性比色呼气末二氧化碳检测仪连接到ET导管上。如果没有比色变化，护理人员会重新评估导管位置，并可对患者重新插管。在医院对导管位置进行验证。指示护理人员在到达医院时联系基站并报告比色变化。ROSC定义为在到达医院前恢复自主维持的脉搏。
在1990年12月至1993年5月期间，对566例院外心脏骤停患者进行了ET导管放置。566次插管中有541次（95.6%）出现颜色变化。在1例有颜色变化且院外有导管放置正确临床证据的病例中，在医院确定导管位于食管内。其余566根导管中的565根（99.8%）放置正确得到验证。在566例有比色变化的患者中，91例（16%）实现了ROSC，而在25例无颜色变化的患者中有1例（4%）实现了ROSC。在一个亚组（n = 179）中，颜色变化程度与ROSC高度相关（p = 0.004）。
一次性比色呼气末二氧化碳检测仪在验证院外心脏骤停患者ET导管正确放置方面似乎是可靠的。颜色变化程度与ROSC的可能性相关。
