2006 OPEN FORUM Abstracts
CASE STUDY: A TRIAL COMPARING THE EFFECTIVENESS OF THE MERCURY MINI STATCO2® AND THE NELLCOR PEDI-CAP® IN THE PRESENCE OF ENDOTRACHEALLY ADMINISTERED MEDICATIONS
Shawn Hughes B.S., RRT, Betty L. Blake B.S., RRT, NPS, Lee Woods, MD,
PhD. The
Johns
Hopkins
Hospital
,
Baltimore
,
Maryland
.
Introduction: The new American Heart Association guidelines
for intra-hospital resuscitation recommend the use of an exhaled carbon dioxide
(CO2) as the primary means of confirming correct endotracheal tube
(ETT) placement. We compared two exhaled
CO2 detectors, Nellcor Pedi-Cap® and Mercury Mini-STAT®, for
accuracy of CO2 detection in a neonatal resuscitation situation in
which medications are administered via the ETT.
Case Summary: We tested several drugs that might be given
via the ETT during resuscitation for their effect on the two exhaled CO2 detectors. Normal saline solution (NSS)
was used as the control. Each brand of
exhaled CO2 detector was tested in two ways. First, several drops of each drug were put
directly onto the detection filter of the two CO2 detectors and
color change recorded (see chart below).
Next, each drug was delivered in an appropriate neonatal dose into a
neonatal size test lung via an ETT. A
resuscitation bag and CO2 detector were attached to the test lung
and several breaths delivered. Color
change in the CO2 detector was again recorded (see chart below).
| Nellcor Pedi-Cap® Positive color change from purple to yellow | ||
| Drug/Dose | Positive | Negative |
| Normal Saline | With vapor and drops | |
| Infasurf® | 1 cc turned yellow | With vapor |
| Epinephrine 1:10,000 0.1 mcg | With drops and vapor | |
| Atropine 0.1 mcg | With drops | With vapor |
| Narcan® | 0.2 cc to turn <2% | |
| Mercury Mini-STATCO2® Positive color change from blue to yellow | ||
| Drug/Dose | Positive | Negative |
| Normal Saline 1 cc | With vapor and drops | |
| Infasurf® | 0.8 cc turned yellow | With vapor |
| Epinephrine 1:10,000 0.1 mcg | With drops | With vapor |
| Atropine 0.1 mcg | With drops | With vapor |
| Narcan® | 0.1 cc turned yellow | 0.1 cc to turn 1-2% |
Discussion: Our study shows that a false positive CO2 detection result can occur when resuscitation medications are used. All of the medications tested caused a false
positive result when the medication contacted the detection filter directly. This could occur if medication is splashed on
the detector or coughed up the ETT by the infant. When medications were administered through
the ETT into a test lung, epinephrine vapor also caused a false positive result
with the Nellcor Pedi-Cap® within one to two breaths from the resuscitation
bag. The Mercury Mini-STAT® CO2 did not give a false positive result with epinephrine vapor. NSS control did not cause a color change on
either exhaled CO2 detector with drops or vapor.
Conclusion: Resuscitation medications can cause a false
positive result with exhaled CO2 detectors. This could result in an incorrect assumption
that the infant is successfully intubated.
Exhaled CO2 detectors are a good resource for confirming a
successful intubation along with auscultation, but caution should be exercised
when used during resuscitation.