The AAGBI (Association of Anaesthetists of Great Britain and Ireland) stated, almost a decade ago, that ETCO2 (end-tidal carbon dioxide concentration) is essential to the safe conduct of anaesthesia. They also recommend that during transfer “if patients’ lungs are ventilated, expired carbon dioxide should be monitored continuously” and this is further expanded upon in 2006 by the same body in the context of the management of head injury patients during transfer.
There are several benefits achieved from the use of continuous numerical display of ETCO2 monitoring. It is a valuable tool to confirm airway placement and patency, it provides an indication of efficacy of ventilation and it can illustrate a reduction in cardiac output early in this pathophysiological process (often before other clinical or measured signs are apparent).
With the above in mind and because of other difficulties in the prehospital environment which make some elements of assessment more difficult we set out to find a truly portable capnometer that fulfilled all our requirements.
I have been using EMMA, a compact portable emergency mainstream capnometer on all my patients with secure (LMA’s) or definitive (ETT’s) in the out-ofhospital arena for almost a year now. With no warm-up time EMMA displays ETCO2 values after one breath and respiratory rate values after the second breath which update every breath thereafter. EMMA can be quickly and directly connected to an endotracheal tube, laryngeal mask or facial mask via the disposable airway adapters.
Initially I trialled the EMMA in a controlled environment in theatres comparing the accuracy with the anaesthetic side-stream monitors and was favourably impressed. EMMA is simple and easy to use and is of a size so as not to cause any additional concerns. EMMA has an easy to read LED display for both ETC02 and Respiratory rate values with a bar display for respiratory rate, the lack of a wave-form did not cause any concern in the care of my pre-hospital patients.
I have used it on numerous patients out-of-hospital and found it to be hugely valuable in providing effective clinical care. In view of this and the recommendations mentioned from the
AAGBI, I would have no hesitation in recommending the EMMA ETCO2 monitor. I look forward to the time when pre-hospital practitioners in our environment, whether they be physicians, paramedics or nurses have appropriate technical and non-technical training that this form of monitoring becomes minimum accepted standard.
Dr M Bloch
Consultant Anaesthetist
Honorary Clinical Senior Lecturer
Royal Aberdeen Children's Hospital / Aberdeen Royal Infirmary (University of Aberdeen)
References
“Recommendations for the Standards of Monitoring during Anaesthesia and in Recovery.” AAGBI, London, 2007.
“Transfer of Patients with Head Injury.” AAGBI, London, 2006.
“Recommendations for Standards of Monitoring during Anaesthesia and in Recovery.” AAGBI, London, 2000.