ABSTRACTS
ETCO2 Documentation Varies by EMS Clinician Impression and Airway Management ChoicesAuthor: Mitchel Reuter MSEMS, CCEMT - P, NRP | EMS Instructor | University of Wisconsin Hospitals and Clinics Associate Authors: Powell, Jonathan, R. MPA, NRP (Affiliation: ImageTrend Inc.)
Introduction End-tidal carbon dioxide (ETCO2) is an important pre-hospital diagnostic tool used to measure the carbon dioxide expelled from the body through ventilation. Often cited as necessary for critically ill patients or patients requiring positive pressure ventilation, its documented use in emergency medical services (EMS) care delivery is poorly described. Our objective was to quantify the documented use of ETCO2, overall and among common clinician impressions and airway device usage, in a national EMS dataset. Methods We conducted a retrospective, descriptive evaluation of the 2023 ImageTrend Collaborate dataset. We included 9-1-1 dispatched EMS activations with advanced life support capability that resulted in treatment and transport. We classified primary and secondary EMS clinician impressions into investigator-driven a priori categories of respiratory distress, non-traumatic pain, congestive heart failure, non-traumatic shock, trauma, and diabetes-related activations. We further investigated ETCO2 documentation across activations with positive pressure ventilation device use (endotracheal tube, supraglottic, bag-valve mask only). We used descriptive statistics for prevalence of documented use (yes/no) and used STATA MP 18 for all analyses. Results We included 4,023,594 activations for analysis. Overall, 470,363 (12%) activations documented ETCO2 use during patient care delivery. Among EMS clinician impressions we noted varied documented use: respiratory distress (30%), heart failure (34%), non-traumatic shock (29%), non-traumatic pain (7%), trauma (7%), and diabetes-related (13%). We further noted differences in documentation of ETCO2 among provision of positive pressure ventilation: endotracheal tube (83%), supraglottic (77%), and bag-valve mask only (47%). Conclusions We found varied documented use of ETCO2 by EMS clinicians in a national EMS activation dataset. Our findings of documented ETCO2 use suggest that a renewed focus on clinical indications, as well as documentation practices of this critical skill, may be needed for optimal patient assessment and care.
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