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Mitigating Operating Room Fires: Development of a Carbon Dioxide Fire Prevention Device

Culp, William C. Jr MD; Kimbrough, Bradly A.; Luna, Sarah AA; Maguddayao, Aris J. AA

doi: 10.1213/ANE.0000000000000133
Technology, Computing, and Simulation: Technical Communication

Operating room fires are sentinel events that present a real danger to surgical patients and occur at least as frequently as wrong-sided surgery. For fire to occur, the 3 points of the fire triad must be present: an oxidizer, an ignition source, and fuel source. The electrosurgical unit (ESU) pencil triggers most operating room fires. Carbon dioxide (CO2) is a gas that prevents ignition and suppresses fire by displacing oxygen. We hypothesize that a device can be created to reduce operating room fires by generating a cone of CO2 around the ESU pencil tip. One such device was created by fabricating a divergent nozzle and connecting it to a CO2 source. This device was then placed over the ESU pencil, allowing the tip to be encased in a cone of CO2 gas. The device was then tested in 21%, 50%, and 100% oxygen environments. The ESU was activated at 50 W cut mode while placing the ESU pencil tip on a laparotomy sponge resting on an aluminum test plate for up to 30 seconds or until the sponge ignited. High-speed videography was used to identify time of ignition. Each test was performed in each oxygen environment 5 times with the device activated (CO2 flow 8 L/min) and with the device deactivated (no CO2 flow-control). In addition, 3-dimensional spatial mapping of CO2 concentrations was performed with a CO2 sampling device. The median ± SD [range] ignition time of the control group in 21% oxygen was 2.9 s ± 0.44 [2.3–3.0], in 50% oxygen 0.58 s ± 0.12 [0.47–0.73], and in 100% oxygen 0.48 s ± 0.50 [0.03–1.27]. Fires were ignited with each control trial (15/15); no fires ignited when the device was used (0/15, P < 0.0001). The CO2 concentration at the end of the ESU pencil tip was 95%, while the average CO2 concentration 1 to 1.4 cm away from the pencil tip on the bottom plane was 64%. In conclusion, an operating room fire prevention device can be created by using a divergent nozzle design through which CO2 passes, creating a cone of fire suppressant. This device as demonstrated in a flammability model effectively reduced the risk of fire. CO2 3-dimensional spatial mapping suggests effective fire reduction at least 1 cm away from the tip of the ESU pencil at 8 L/min CO2 flow. Future testing should determine optimum CO2 flow rates and ideal nozzle shapes. Use of this device may substantially reduce the risk of patient injury due to operating room fires.

From the Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Hospital, Temple, Texas.

Accepted for publication January 6, 2014.

Funding: This article is supported, in part, by the National Science Foundation (Arlington, Virginia) under grant no. 0855343; the Texas A&M University College of Medicine Undergraduate Research Award (College Station, Texas); the Scott & White Resident Mentorship Award, and by institutional, departmental, and investigator sources.

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to William C. Culp, Jr., MD, Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Memorial Hospital, 2401 South 31st St., Temple, TX 76508. Address e-mail to

© 2014 International Anesthesia Research Society