Prehospital Use of Waveform Capnography in Intubated Neonates

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Anesthesiology

Background:

• Continuous waveform capnography is standard for monitoring endotracheal tube (ETT) placement in adults.
• Neonatal intubation presents challenges due to low tidal volumes and the bulk of capnography equipment, risking ETT dislodgement.
• A potential disparity in care exists for intubated neonates compared to adults regarding continuous ETT monitoring.

Purpose of the Study:

• To investigate the utilization of continuous end-tidal carbon dioxide (ETCO2) monitoring in intubated neonates versus other age groups in the prehospital setting.
• To identify potential gaps in the standard of care for neonatal endotracheal tube placement verification.

Main Methods:

• Retrospective chart review of intubated patients (neonates, children, adolescents, adults) from a single air medical agency.
• Data collected included intubation attempts, success, and capnography use.
• Statistical analysis using Chi Square Goodness of Fit Tests.

Main Results:

• Continuous waveform ETCO2 monitoring was used in 62% of successfully intubated neonates, significantly less than children (94%), adolescents (95%), and adults (97%).
• Statistically significant differences in capnography use were observed between adults and neonates (p=0.013) and among neonates, children, and adolescents (p=0.049).

Conclusions:

• Continuous ETCO2 monitoring is underutilized in intubated neonates in the prehospital setting, indicating a gap in the standard of care.
• Further research is needed to confirm these findings across the industry and assess the impact on undetected ETT displacement in neonates.