Capno 101: What is Airway Management?
Airway management is a critical EMS skill. Simply put, a patient without an airway will not survive – but placement of an advanced airway device in critically ill and injured patients is a high-risk procedure, and a misplaced airway can cause permanent disability or death.
The capnography waveform can identify and help to differentiate the causes of symptoms by providing an indication of reactive airway disease even before the typical observable increased expiratory phase begins. With capnography, providers are able to make a much earlier and more educated decision on whether or not to intubate the patient to protect the airway or to avoid impending respiratory collapse.
Capnography and Airway Management
When added to a thorough history and physical exam, waveform capnography is a valuable assessment tool to determine the severity of a patient’s respiratory distress, to guide treatment decisions in the prehospital environment and to monitor the patient’s response to those treatments.
“Waveform capnography is the most reliable tool for confirming placement of an advanced airway tube or device,” writes EMS instructor Bob Sullivan. Capnography enables objective monitoring of end-tidal CO2 levels and the patient’s ventilation rate through all phases of contact, and changes are immediately evident if the airway is displaced or a problem with ventilation develops.
Learn more about Airway Management:
EMS1.com: Take charge of the airway with tunnel vision focus
End-tidal waveform capnography provides reliable means to prevent a misplaced endotracheal tube and is becoming the standard of care in many jurisdictions.
EMS1.com: It’s All About the Breath: Capnography and Airway Management (webinar)
This case-based presentation discusses the numerous decisions to be made during advanced airway management, including intubation, rapid sequenced induction and capnography.
EMS1.com: Using capnography to determine intervention
A thorough assessment is critical to patient survival. Capnography can be used as part of the assessment toolkit and allows providers to adjust treatment in progress. Using etCO2 readings can help create better outcomes for a variety of patients, providing insight into circulatory status on spontaneously breathing patients as well as intubated patients.
Respiratory Care: Capnography/Capnometry During Mechanical Ventilation: 2011
This update to clinical practice guidelines is based on a review of more than 200 clinical studies and systematic reviews, as well as the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The study finds that “Continuous-waveform capnography is recommended, in addition to clinical assessment, to confirm and monitor correct placement of an endotracheal tube” and that “Continuous capnometry during transport of the mechanically ventilated patients is suggested.”
Expert Review of Respiratory Medicine: Current applications of capnography in non-intubated patients
The Expert Review of Respiratory Medicine published a review assessing clinical guidelines recommending capnography to assess adequacy of ventilation in non-intubated patients. The study found that “Capnography should be routinely used for non-intubated patients at risk for respiratory depression, in particular those receiving supplemental oxygen.”
British Journal of Anaesthesia: Complications and failure of airway management
This analysis of major airway complications identifies areas where practice and outcomes are suboptimal, finding that “a significant proportion” of airway complications occur in the emergency setting, often where treatment is administered without capnography. The study concluded that providers should “always use capnography to confirm successful intubation and ventilation.”