Capnography for Monitoring End-Tidal CO₂ in Hospital and Pre-hospital Settings: A Health Technology Assessment

Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO₂) in patients receiving general anesthesia. ETCO₂ monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption.

The growing utility of ETCO₂-monitoring technology in diverse clinical settings, the uncertainty regarding the clinical and cost-effectiveness of capnography devices, and access and implementation issues were the main drivers for this health technology assessment (HTA).

Contents

• Reviewers
• Authorship
• Acknowledgements
• Conflicts of Interest
• Abbreviations
• Executive Summary
• 1. Introduction
• 2. The Issue
• 3. Objectives
  • 3.1 Research Questions
• 4. Clinical Review
  • 4.1 Methods
  • 4.2 Results
• 5. Economic Review
  • 5.1 Review of Economic Studies
  • 5.2 Primary Economic Evaluation
• 6. Health Services Impact
  • 6.1 Methods
  • 6.2 Implementation Considerations
• 7. Discussion
  • 7.1 Summary of Results
  • 7.2 Generalizability of Findings
  • 7.3 Study Limitations
  • 7.4 Directions for Future Research
• 8. Conclusions
• References
• APPENDIX 1 Literature Search Strategy
• APPENDIX 2 Detailed Methods and Results of the Review of Economic studies
• APPENDIX 3 Full-Text Screening Checklist
• APPENDIX 4 Data Extraction Form — Clinical Review
• APPENDIX 5 Study Selection Flow Diagram — Clinical Review
• APPENDIX 6 List of Studies Excluded From the Clinical Review and Reasons For Exclusion
• APPENDIX 7 Detailed Study Characteristics
• APPENDIX 8 Details of the Capnography Devices
• APPENDIX 9 Detailed Patient Characteristics
• APPENDIX 10 Detailed Tables for Risk of Bias Assessment
• APPENDIX 11 Detailed Outcome Results — Clinical Review
• APPENDIX 12 Clinical and Cost Inputs for the Economic Model
• APPENDIX 13 Detailed Economic Results

About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. Views: The views expressed herein are those of CADTH and do not necessarily reflect the views of our funders.

Suggested citation:

Capnography for Monitoring End-Tidal CO₂ in Hospital and Pre-hospital Settings: A Health Technology Assessment. Ottawa: CADTH; 2016 Mar. (CADTH health technology assessment; no. 142).

Production of this report is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Prince Edward Island, Saskatchewan, and Yukon. The Canadian Agency for Drugs and Technologies in Health (CADTH) takes sole responsibility for the final form and content of this report. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government.

Reproduction of this document for non-commercial purposes is permitted provided appropriate credit is given to CADTH.

CADTH is funded by Canadian federal, provincial, and territorial governments.