Use of capnography in the delivery room for assessment of endotracheal tube placement

Objective: Determine whether end-tidal CO₂ (ETCO₂) monitoring allows for more rapid discrimination of tracheal versus esophageal intubation than standard clinical assessment during neonatal resuscitation in the delivery room. Study Design: Endotracheal tube (ETT) placement was assessed using either a hand-held monitor that displayed graphic and quantitative ETCO₂ by an investigator not involved in the resuscitation, or using clinical parameters by the resuscitation team unaware of the ETCO₂ data. The time differences between ETCO₂ and clinical determinations of ETT placement were compared. Results: Capnography correctly identified all 16 tracheal and 11 esophageal intubations performed on 16 study infants. The median times (and range) in seconds required for capnographic and clinical determination of tracheal intubation were 9 (4 to 26) vs. 35 (18 to 70), p<.001, and for esophageal intubation were 9 (4 to 17) vs. 30 (25 to 111), p=.001. Conclusion: Capnography allowed more rapid determination of both tracheal and unintended esophageal intubation than clinical assessment.