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Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Evidence-based Practice and Quality Improvement

Confirmation of tracheal tube placement and tracheal tube removal practice following unsuccessful resuscitation

1AP1-5

Reddy, H. P.; Rassam, S. S.; Hodzjic, I.; Chethan, D. B.; Hall, J. E.

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European Journal of Anaesthesiology: June 2011 - Volume 28 - Issue - p 8
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Background and Goal of Study: Clinical confirmation of correct endoracheal (ETT) position during and following a cardiopulmonary resuscitation attempt can be misleading. The last Confidential Enquiry into Maternal and Child Health (CEMACH) highlighted the limitations of current methods of confirmation. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommend using capnography to confirm the ETT position and this is now the minimum safe standard across the UK.

However, there may not be sufficient carbon dioxide delivered to the lungs during a cardiac arrest which renders this technique fallible. There are no clear guidelines regarding the confirmation of correct ETT placement and its removal after an unsuccessful attempt at resuscitation.

Materials and Methods: A questionnaire was sent to anaesthetists of all grades working in Wales. The questionnaire was anonymous and asked the following questions:

  1. What devices are available in your department to confirm ETT intubation and what is the anaesthetists' preference.
  2. Anaesthetists' attitude towards ETT removal after an unsuccessful resuscitation.
  3. Whether or not anaesthetists felt there was a need for guidelines regarding airway management after failed resuscitation.

Results and Discussion: Replies were received from 345 of 571 posted questionnaires (60% response rate). The methods used to confrim correct ETT placement were:

93% direct laryngoscopy and auscultation

  • 61% capnography
  • 4% colorimteric carbon dixide detectors
  • 2% impedance respirometry
  • 9% used other methods such as misting of the tube and chest movement.
  • Regarding ETT removal following unsuccessful resuscitation, 50% would remove ETT, 30% would leave it in situ and the remainder were unsure of what to do. However, of those respondents who would extubate the patient, only 37% confirmed ETT position prior to removal. Almost 50% said they would like formal guidelines on the subject, 15% were unsure and 35% thought they wouldn't be necessary.

Conclusion(s):

There was no consensus view on extubation practice, following unsuccessful resuscitation

  1. We recommend confirming ETT position prior to extubating, this was not done universally
  2. 50% felt there was a need for guidelines regarding extubation post resuscitation
  3. Documentation about airway management during a resuscitation was extremely poor.

References:

CEMACH report 2003 - 2005 AAGBI minimum safe monitoring standards
    © 2011 European Society of Anaesthesiology