Stand-alone ETCO2 Monitors

My former resident Seth Trueger (@mdaware) is missing having waveform capnographs at every resuscitation bedside. He is looking for a stand-alone unit for his department to purchase.

First person I suggested he reach out to is prehospital master, Christopher Watford who wrote back this,

As far as handheld goes, Nellcor makes the N-85 which has both EtCO2 (quantitative and waveform) and SpO2. I think new they’re around $4k. BCI offers the Capnocheck, which is good too, but I think has more options and is pricier. Oridion has the priciest, but a lot of prehospital and inhospital cardiac monitors use their technology.

 It also uses semi-standard adaptors, so you may get lucky with some other section of your hospital using the adaptors. EMS in your area may use it too, potential cost sharing opportunity.
We’ve got EtCO2 built into our Philips MRx’s, both our LP12′s and LP15′s, and all of our Zoll’s (E, M, and now the X-series). So we don’t really use the handheld units in EMS. You could look into upgrading inhospital monitors, usually its a $2-3k “add on” (basically a software upgrade if you’ve got the port).
Let me know if you need anything else!
Update: The new Nellcor N-85 is the Oridion Microcap. I hope they kept the price the same

Do any of you have units you use and like?

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Comments

  1. Wouldn’t want to miss it… Price could be even a bit higher though depending where you look.

    We use the Oridion Plus with the Filterline tubing (ETT and nasal) monitors in our prehospital HEMS and ALS ground units. Sadly lots of receiving EDs still don’t use it (my wife’s, also emergency doctor, is the only ED in the vicinity which regularly use).
    Still have to see the model fail, even though I strongly recommend the rubber casing!!! At least prehospital…

  2. minh le cong says:

    Du Canto has one and I am considering buying one too. EMMA Capnometer
    http://www.phasein.com/Products/EMMA-Capnometer/EmmaNews/60-grams-capnometer-for-the-field1/

    Its not waveform but works and is about $1000 AU
    The NelLcor units are pretty cool as standalone waveform capnometers.
    But Seth is into health policy , right? His next project is to lobby his ED to get waveform monitors or turn on the function of their current monitors!

  3. Shirah says:

    Work in veterinary critical care, and we recently got to try out the handheld NelCor CO2/SpO2 monitor and so far everybody loveloveloves it. It displays waveform and/or just the numbers.
    Patient variations: Where I work, we see a wide variety of patient sizes, from 65kg, and the monitor handles the range well, especially given that it only has two adapters– pediatric or adult.
    Portability: We’ll take it along for patient transports, and it handles being in a moving vehicle well enough. The ETCO2 piece works just fine. SPO2 has trouble, but that seems to be a function of how dogs/cats are hooked up to the monitor, NOT the monitor itself. (Our SPO2-only monitors have the same issue.)
    Cost: No idea, sorry. But if vet med can afford it, it can’t be THAT bad, right?

  4. Jimmy D says:

    Take a look at the Respironics Tidal Wave 610–it also contains a pulse ox probe. With an ECG monitor and a manual BP cuff, you could round out your prehospital monitor stuff with this thing alone. Yes, I have one too, and it’s cool. The EMMA is awesome, as Minh suggested. I used one in a cardiac arrest in one of our suburban ED’s, and I detected ROSC through capnography on the EMMA immediately before we found a pulse. Then, on the same patient, I detected cardiac arrest (again) via capnography on the EMMA. Seth, if you must have an EtCO2 monitor, and you are alone in wanting it, get the EMMA, or buy the Respironics unit (used-reconditioned)–it will keep your budget under control. The Respironics unit has the capability for data-logging—there was a research group using them to collect data for a prehospital study, I just forget the details of that.

  5. Jimmy D says:
  6. Jason RN, CFRN says:

    I have personal experience with the BCI Smiths Capnocheck and the Oridion Microstream. The Capnocheck is not a great unit in my opinion, primarily because of the adjuncts used with the monitor and the fact the gas sample tubing falls out of the monitor CONSTANTLY. It is a ‘slip’ connection, there is no leur lock to secure the patient circuit into the monitor. We use this in the HEMS prehospital setting, and after moving a critical field RSI patient, I look down at the monitor and…no waveform, which at first glance makes one wonder if the ETT was dislodged in transit. Also, the different function buttons are poorly labeled, and if is easy to change screens indavertently, so if you are using it for primary confirmation of ETT placement, it can be frustrating seeing a flat waveform and then seeing you switched to the trends page on mistake. It seems silly, but it is a big deal if the unit is going to be used for the prehospital setting or transport of the intubated hospital patient for diagnostic studies out of the ICU or ER. Also the BCI Capnocheck tubing is non-universal, you can not use it on any other machines in the market and the ear probe does not work well.

    The Oridion Microstream is a great product in my opinion, we trialed it for a month and it had great performance. It has waveform also, and it uses the universal Etco2 gas sampling sets for ETT and nasal cannula, which also work in the Philips mRx and Propac/Zoll MD monitors. This set secures into the monitor with a leur lock system that does not dislodged with purposely removing it.

    We only bought one Capnocheck thankfully, and we are still using the old Respironics Tidal Wave Novametrix units from the San Diego field RSI study years back, they work great except they are no longer supported, and they use the infrared mainstream etco2 measurement adapters, which sometimes dont work great in high secretion settings. Another thing we love about this unit is the ear probe which gives us much better central monitoring of Spo2. I would not recommend buying these units because it is very difficult to find parts and obtain service on them, they are no longer supported.

    In my opinion, the waveform is essential.

    • Jason–that is EXACTLY the kind of real-world feedback you rarely get until you have already wasted $1000′s of dollars on a product chosen from a catalog. Thank you!

  7. Don Diakow says:

    Folks………use the Spo2 and Etco2 off the lp-15 daily both ET and nasal. Really trying to push my team here to regularly use the nasal ETc02 and learn the wave forms and numbers for a wide subset of patients. Had success in our bradypnea patients i.e.: OD patients it’s great when you titrating Narcan to improve ETc02 numbers but keeping the patient from waking up and trashing the crew and back of the EMS unit.
    I do have a question……..have heard that the numbers we get off the LP-15 and real blood gas numbers can be off as far as 5%? Any one have thoughts or real experience with that?

    • In sick patients, the only reliable relationship between PaCO2 and ETCO2 is that the PaCO2 will be at least as high as the ET. Everything else is variable depending on perfusion/CO.

  8. Thanks for all the input!

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