PP056 [Resuscitation, Stabilisation & Transport » Resuscitation]: EPIDEMIOLOGY OF CARDIOPULMONARY ARREST AND OUTCOME OF RESUSCITATION IN PICU ACROSS CHINA: A PROSPECTIVE MULTICENTER COHORT STUDY

Abstract

BACKGROUND AND AIM:The detection of end-tidal carbon dioxide (ETCO2) in exhaled breath through the endotracheal tube (ETT) is the gold standard for confirming correct ETT placement. However, ETCO2 readings may produce unreliable results when pulmonary blood flow is diminished during cardiopulmonary resuscitation. Failure to detect incorrect ETT placement may result in hypoxia, brain injury, and death. We hypothesize that using a hold-up test with an ETT, without a bougie, could be a reliable method of confirming endotracheal intubation when ETCO2 fails during cardiac arrest. METHOD:After completion of a separate experimental protocol, ten deceased piglets were randomly intubated (esophagus or trachea) 20 times. For each trial, a blinded evaluator used the hold-up test to determine ETT placement (tracheal or esophageal) by advancing the tube until it stopped (tracheal) or continued to the hub (esophageal). After recording the evaluator's decision, direct palpation was used as the gold standard for confirming ETT placement. RESULTS:Out of 100 esophageal and 100 tracheal intubations, 3 false positives and 0 false negatives were recorded (sensitivity: 100%, specificity: 97%). For three esophageal intubations, the ETT met resistance before reaching the hub. Average distances of ETT advancement were 16.6 cm for esophageal and 11.4 cm for tracheal. CONCLUSIONS:In this piglet model, the hold-up test is a fast, easy, and inexpensive test to confirm ETT placement with high sensitivity and specificity. Further investigation is needed to determine clinical reliability.