On page 49 of the European Paediatric Advanced Life Support manual [EPALS] (4th edition) there is a statement regarding end-tidal carbon dioxide (ETCO2) traces during CPR which states “The absence of exhaled CO2 during CPR does not guarantee tube misplacement”. Whilst this is technically correct, particularly in a small child with a leak around a tracheal tube, it may lead to false reassurance and unrecognised oesophageal intubation.
The Royal College of Anaesthetists (RCoA) have been notified of cases where this has occurred and have developed a teaching module called “No trace, wrong place” which emphasises that although an attenuated trace is common during CPR, a completely flat ETCO2 trace should be assumed to be a misplaced tracheal tube until proven otherwise. The next edition of our EPALS manual will reflect this, however, in the meantime, we will be informing all Instructors of this, and emphasising this point during the course.
For further information please visit the RCoA website.