Misplaced Endotracheal Tubes in the Prehospital Setting

Prehospital intubation has the potential to save lives, but misplaced tubes, particularly those placed in the esophagus, can have devastating and potentially lethal outcomes. These authors evaluated the rate of unrecognized misplacement of endotracheal tubes by emergency medical services personnel in a mixed urban, suburban, and rural prehospital setting.

Over a 14-month period, all patients arriving in the emergency department who had been intubated in the prehospital setting were evaluated by emergency physicians for accuracy of tube placement using auscultation and infrared CO₂ detectors and, if needed, esophageal detector devices, direct laryngoscopy, and chest X-ray. Of 167 intubations, 136 were deemed successful by EMS personnel; compl…