Sub-Saharan Africa: 11,000 potentially fatal anaesthetic accidents could be prevented every year by access to a simple breathing monitor

A new study, the Global Capnography Project (GCAP), published 26 September 2018, in the journal Anaesthesia, has clearly identified the need for middle and low-income countries to have access to a simple and life-saving method of monitoring a patient’s breathing, called capnography, in operating theatres and in intensive care units.

Capnography is an essential monitor for safe anaesthesia and is widely used in high-income countries as part of major improvements in the safety of anaesthesia care. A landmark study in 2011, the 4th National Audit Project (NAP4), further confirmed the importance of capnography both in the operating theatre and especially in the intensive care unit. Despite this, the device is hardly ever available in low-income countries.

The GCAP team set out to measure the availability of capnography and determine whether its introduction was feasible and could improve patient care in a low-income country. A pilot site was identified in Malawi and forty capnographs were donated by Medtronic to eight hospitals in the southern part of the country. In addition, thirty-two anaesthesia providers at these hospitals received a one-day capnography training course.

Prior to the pilot project, there was only one capnograph in the southern region of Malawi, across eight hospitals. During the six-month pilot, 699 episodes of monitoring with the capnographs were recorded and 90% of the anaesthesia providers trained believed that the use of capnography had saved lives. They reported that a minimum of 57 lives had been saved during the six months of use.

Oesophageal intubation (accidently placing a tracheal tube in the patient’s oesophagus) and breathing circuit disconnections are two of the most important incidents in operating theatres and intensive care units that capnography monitoring can detect. Both of these can lead to significant patient harm and mortality if not identified early and corrected quickly.

During the six-month pilot, 44 oesophageal intubations were detected by capnography. From this, the GCAP team made an estimation that with a population of 7.5 million in Southern Malawi there is a rate of 11.7 oesophageal intubations per million population per year. Assuming Southern Malawi is representative of sub-Saharan Africa as a whole (with a population of 1,022 million), the team then went on to estimate that over 11,000 oesophageal intubations could occur per year in the region. These incidents pose a very significant patient safety risk that could be prevented by access to capnography. The GCAP team estimated that there are at least 70,000 operating theatres in the world without Capnography.

Prof Ellen O’Sullivan from GCAP Team, said: “We believe that this is one of the most important projects in anaesthesia safety in the last decade. Our research clearly shows that lives are at risk in low-income countries due to an absence of a simple method of monitoring breathing, called capnography. This is despite international standards recommending its use. We are calling for the development of an international project to make global capnography to become a reality, so that like pulse oximetry, it can be included the World Health Organisation (WHO) surgical safety checklist to help improve patient safety worldwide All relevant organisations should consider taking this forward.”

Dr Delia Mabedi from Zomba Hospital, Malawi commented: “These results show that capnography is desperately needed to help save patients’ lives in our operating theatres and ICUs. We found the equipment robust and easy to use. We plead with the international anaesthesia community to support the dissemination of the GCAP project throughout Malawi and other sub-Saharan African countries.”

Vafa Jamali, senior vice president and president of Respiratory, Gastrointestinal and Informatics, which is part of the Minimally Invasive Therapies Group at Medtronic commented, "Medtronic is grateful for the opportunity to participate in the GCAP project that demonstrated the major clinical benefits of monitoring patients breathing with capnography. We look forward to working with the clinical community to address the global need for this technology and to keep patients safe worldwide.”

 

Notes for editors:
The study is called: ‘Global Capnography Project (GCAP): implementation of capnography in Malawi - an international anaesthesia quality improvement project’ and will be published in the journal Anaesthesia on 26 September and will be available at  https://www.onlinelibrary.wiley.com/doi/10.1111/anae.14426

Authors of the report are
R. Jooste1, F. Roberts2, S. Mndolo3, D. Mabedi4, S. Chikumbanje5, D. K. Whitaker6 and E. P. O’Sullivan7.
1,2 Registrar, 7 Professor, Department of Anaesthesia, St James Hospital, Dublin, Ireland
3, 4 Consultant, Department of Anaesthesia Queen Elizabeth Central Hospital, Blantyre, Malawi
5 Consultant, Department of Anaesthesia Zomba District Hospital, Zomba, Malawi
6 Consultant Anaesthetist, Manchester, UK

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