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Detection of exhaled carbon dioxide following intubation during resuscitation at delivery
  1. Katie A Hunt1,2,
  2. Yosuke Yamada1,2,
  3. Vadivelam Murthy1,2,
  4. Prashanth Srihari Bhat1,2,
  5. Morag Campbell3,
  6. Grenville F Fox4,
  7. Anthony D Milner1,2,
  8. Anne Greenough1,2,5
  1. 1 MRC & Asthma UK Centre in Allergic Mechanisms in Asthma, King’s College London, London, UK
  2. 2 Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
  3. 3 Neonatal Unit, Southern General and Yorkhill Hospitals, Scotland, UK
  4. 4 Evelina Children’s Hospital Neonatal Unit, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
  5. 5 National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, UK
  1. Correspondence to Professor Anne Greenough, King’s College Hospital, London SE5 9RS, UK; anne.greenough{at}


Objectives End tidal carbon dioxide (ETCO2) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO2 following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant’s condition after birth).

Design Analysis of recordings of respiratory function monitoring.

Setting Two tertiary perinatal centres.

Patients Sixty-four infants, with median gestational age of 27 (range 23–34)weeks.

Interventions Respiratory function monitoring during resuscitation in the delivery suite.

Main outcome measures The time following intubation for ETCO2 levels to be initially detected and to reach 4 mm Hg and 15 mm Hg.

Results The median time for initial detection of ETCO2 following intubation was 3.7 (range 0–44) s, which was significantly shorter than the median time for ETCO2 to reach 4 mm Hg (5.3 (range 0–727) s) and to reach 15 mm Hg (8.1 (range 0–827) s) (both P<0.001). There were significant correlations between the time for ETCO2 to reach 4 mm Hg (r=−0.44, P>0.001) and 15 mm Hg (r=−0.48, P<0.001) and gestational age but not with the Apgar scores.

Conclusions The time for ETCO2 to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO2 monitoring. Capnography is likely to detect ETCO2 faster than colorimetric devices.

  • end tidal carbon dioxide
  • resuscitation
  • intubation

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  • Contributors KAH and YY analysed the data. VM and PSB collected the data. AG, ADM, MC and GFF designed the study. All authors were involved in the production of the manuscript and approved the final version.

  • Funding YY was supported by an Specialised Laboratory Equipment (SLE) and Sata fellowship. KAH and PSB were supported by the Charles Wolfson Charitable Trust and KAH additionally by SLE. VM was supported by the Guy’s and St Thomas’ Charity. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was provided by the Outer North London Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data can be open for sharing if required.