High Incidence of Misplaced Endotracheal Intubations in the Field

The incidence of unrecognized misplacement of endotracheal tubes (ETTs) inserted in the field has not often been analyzed. Although previous studies have found this incidence to be 5 percent or less, these Florida authors suspected that it was significantly higher in their EMS system. They performed a prospective observational study of 108 patients intubated in the EMS environment before ED arrival.

On arrival of patients in the ED, emergency physicians assessed ETT position by auscultation supplemented by end-tidal CO₂ monitoring, direct laryngoscopy, or both. A full 25 percent of tubes were misplaced; 67 percent of these cases were determined to be esophageal intubations, and 33 percent were hypopharyngeal, with the tip of the tube resting…