The following content is sponsored by Masimo
By Greg Bogosian
EMS1 Contributor
One common issue in EMS as technology has become more and more of an at-the-bedside consideration has been that of space and usability – sure, it’s great that you have all kinds of tools at your disposal, as both an EMT and as a Paramedic, but sometimes putting those tools in place requires diverting your attention from that which matters most: your patient. The old adage of “treat the patient, not the numbers” comes, in part, from that distraction – but a new generation of devices that allow you to see both the patient and those numbers at the same time, in the same visual field are changing the way that adage is applied, by bringing in a truer sense of the phrase “titrate for effect.”
I’d like to take a look at one such device today: Masimo’s EMMA Capnograph. This compact, inline capnograph (measuring 2” by 1.5”) allows for eyes-on monitoring of your patient’s CO2 levels in real time, and includes a comprehensive display that shows the critical information at a glance: EtCO2 , respiratory rate, and a visual capnograph that shows a 14.5-second sweep (historical graph) of CO2 values. All of these are pieces of information that have traditionally required us to turn away from our patient to look at our monitor screen (if they were available at all on that monitor). Looking away distracts our attention from the patient for precious seconds, most critically during our resuscitation calls.
As many EMS providers know, there has been an increasing focus on the use of EtCO2 as the baseline standard for effective ventilation, as well as determining the moment when the heart is functioning during cardiac arrest cases (Return of Spontaneous Circulation, or ROSC). Monitoring CO2 has a broad applicability to assessments ranging from chronic COPD patients to juvenile asthmatics – through the use of capnography as a measurement of the effectiveness of perfusion via gas exchange. Importantly, capnography has been incorporated into the protocols for treatment of patients with elevated intracranial pressure (such as hemorrhagic stroke), where the reduction of the EtCO2 level may significantly change intracranial blood flow. The latest research indicates that capnography leads the EMT to provide ventilation at a rate that maximizes blood flow to an injured brain.
What the Masimo EMMA does is bring all of that information, and therefore access to treatment titration information, directly to the person doing the ventilations. This has pretty broad-ranging implications. In many EMS systems, managing a respiratory/cardiac arrest scene, the person handling the ventilations (both before and after intubation) is an EMT, since ALS providers are busy performing other interventions. At the same time, that ALS provider is also monitoring the data coming from the cardiac monitor, but it’s impossible to do so continuously because, frankly, a lot has to happen in a short period of time. In addition, the EMT providing ventilation may not be able to see the monitor, or the critical values that drive the bag-valve-mask function.
Having the EMMA device in place, however, opens up a new possibility, providing the ventilating EMT the optimal view of that function, allowing the ALS provider to “hand off” an easily interpretable data set to another set of eyes, one whose sole focus is ventilation of the patient and who is therefore constantly watching the patient. Dependent upon the call, the EMT can be given a target of EtCO2 readings, and what numbers would need to be reported to that ALS provider. It also allows for the person performing the ventilations to “aim” for a target EtCO2 if applicable and within ALS protocol for their agency. This is especially useful for patients with head injuries, strokes, cardiac arrest, respiratory arrest, and multiple trauma. Finally, the potential is there for the capnograph to indicate ROSC at the time it actually occurs during a cardiac arrest, and therefore could better direct resuscitation efforts and treatments. The rapid startup and display capabilities of the EMMA device provides those results in just seconds.
Capnography in recent years has been used primarily for confirmation of ET tube placement and the avoidance of gastric insufflation. The EMMA device will allow for that, and much more. EMMA directs resuscitation to improve the quality of prehospital emergency care, and quality of life through the avoidance of disability resultant from poor or no perfusion. Check the EMMA out if you get a chance, and see what the next generation of patient diagnostics looks like.
