Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device.

STUDY OBJECTIVES: To evaluate continuous, semiquantitative end-tidal carbon dioxide (ETCO2) monitoring in the prehospital and emergency department setting for confirming proper endotracheal tube placement and assessing prognosis and blood flow during CPR. TYPE OF PARTICIPANTS: Adult patients were included if an endotracheal tube was inserted by prehospital care providers or emergency physicians for cardiac arrest, respiratory arrest, respiratory insufficiency, or airway protection. DESIGN AND INTERVENTIONS: A small, portable, colorimetric ETCO2 detector was attached to the endotracheal tube immediately after each attempted endotracheal tube insertion. The color of the detector membrane was noted at the seventh breath following intubation. The color also was noted and recorded if there was return of spontaneous circulation (defined as a palpable pulse) immediately prior to and following conversion from manual to mechanical CPR. Survival to hospital admission was used as an end point to assess the prognostic value of the initial ETCO2 reading. MAIN RESULTS: A total of 227 patients (144 with cardiopulmonary arrest) were studied. In the 83 patients intubated but not in cardiopulmonary arrest, a reading on the ETCO2 detector signifying more than 0.5% ETCO2 was 100% sensitive and 93% specific in detecting proper endotracheal tube placement (100% specific with the endotracheal tube cuff inflated). In cardiac arrest patients, a longer period of estimated arrest appeared to be associated with a lower ETCO2 detector reading. A reading signifying more than 0.5% ETCO2 was 69% sensitive and 100% specific in detecting proper endotracheal tube placement. After proper endotracheal tube placement, all cardiac arrest patients who survived to hospital admission had an initial ETCO2 measurement signifying more than 0.5% ETCO2. Return of spontaneous circulation was usually accompanied by an improved ETCO2 value. Mechanical CPR always produced an ETCO2 value that was as high or higher than that produced by manual CPR. CONCLUSION: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. CONCLUSION: The colorimetric ETCO2 device is highly accurate for confirming endotracheal tube position in nonarrest patients. In cardiac arrest patients, a reading signifying more than 0.5% ETCO2 confirms correct endotracheal tube placement, while a value signifying less than 0.5% ETCO2 during resuscitation suggests that something is wrong (eg. esophageal intubation, inadequate circulatory flow, prolonged down-time interval, hypothermia, or significant ventilation/perfusion mismatch).

[Tuberous sclerosis associated with left ventricle rhabdomyoma]. / Esclerose tuberosa com rabdomioma de ventrículo esquerdo.

Female infant, presenting with flexion spasms, skin hypochromatic spots and systolic ejection murmur. A clinical diagnosis of tuberous sclerosis, supported by computerized brain tomography and neurosonographic data, was made. Echocardiographic and cineangiocardiographic studies disclosed an associated tumor in left ventricle outlet. After resection of the rhabdomyoma, the patient is asymptomatic with neural manifestations controlled under valproic acid.

[Early surgical correction of the left coronary artery with origin at the pulmonary trunk. Late development]. / Correção cirúrgica precoce da artéria coronária esquerda com origem em tronco pulmonar. Evolução tardia.

The report of these two cases show the accentuated and progressive increase in the ventricular contractility in the late postoperative period in patients who underwent surgical correction of left coronary artery with origin at the pulmonary trunk. Male and female infants, both developed congestive heart failure not controlled by medical treatment. The diagnosis was made by EKG and confirmed by coronary angiogram. They were surgically treated by translocation of the left coronary artery from the pulmonary artery to the aorta. Nine and seven years later, respectively both patients are free of symptoms with marked recovery of the left ventricle function without alteration in height and weight and in excellent clinical conditions. The early surgical treatment in these cases, even with unfavourable clinical status is the only way to change the natural history of this pathology, with an increase of the ventricular contractility.