Prehospital use of a prototype esophageal detection device: a word of caution!
OBJECTIVE
To determine the effectiveness of a prototype esophageal detection device (EDD) during use in the prehospital setting.


METHODS
Prospective convenience sample in a prehospital setting.


METHODS
Intubated adult patients.


METHODS
The study device was used to determine esophageal or endotracheal placement of endotracheal tubes in intubated patients. Clinical means were used to confirm tube location. A data sheet was completed for each patient.


RESULTS
Of 105 uses of the device, 17 of 17 esophageal tubes were identified correctly (100% sensitivity). Sixty-five of 88 tracheal tubes were correctly identified (78% specificity). There was intermediate reinflation of the device on 13 of the 65 tracheal tubes. Five tests were indeterminate. There were no false negatives (negative predictive value 100%), but 18 false positives (positive predictive value 48%).


CONCLUSIONS
This prototype EDD adequately identifies esophageally placed endotracheal tubes. Correct identification of endotracheally placed tubes was less sensitive. Much work needs to be done regarding the use of negative aspiration devices to identify placement of endotracheal tubes.
Marley
C D
CD
Hanover General Hospital, Pennsylvania 17331, USA.
Eitel
D R
DR
Koch
M F
MF
Hess
D R
DR
Taigman
M A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians / Q000193:education; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires