title: The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians.
abstract: BACKGROUND
  Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster.
  
  
  METHODS
  We performed an observational, prospective study of consecutive patients requiring transport by air and out-of-hospital tracheal intubation, performed by primary emergency physicians to quantify the number of unrecognized esophageal and endobronchial intubations. Tracheal tube placement was verified on scene by a study physician using a combination of direct visualization, end-tidal carbon dioxide detection, esophageal detection device, and physical examination.
  
  
  RESULTS
  During the 5-yr study period 149 consecutive out-of-hospital tracheal intubations were performed by primary emergency physicians and subsequently evaluated by the study physicians. The mean patient age was 57.0 (+/-22.7) yr and 99 patients (66.4%) were men. The tracheal tube was determined by the study physician to have been placed in the right mainstem bronchus or esophagus in 16 (10.7%) and 10 (6.7%) patients, respectively. All esophageal intubations were detected and corrected by the study physician at the scene, but 7 of these 10 patients died within the first 24 h of treatment.
  
  
  CONCLUSIONS
  The incidence of unrecognized esophageal intubation is frequent and is associated with a high mortality rate. Esophageal intubation can be detected with end-tidal carbon dioxide monitoring and an esophageal detection device. Out-of-hospital care providers should receive continuing training in airway management, and should be provided additional confirmatory adjuncts to aid in the determination of tracheal tube placement.
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Goettingen, Germany. atimmer@zari.de
authors.forename: Arnd
authors.initials: A
authors.lastname: Timmermann
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.forename: Christoph
authors.initials: C
authors.lastname: Eich
authors.forename: Markus
authors.initials: M
authors.lastname: Roessler
authors.forename: Ulrich
authors.initials: U
authors.lastname: Braun
authors.forename: William H
authors.initials: WH
authors.lastname: Rosenblatt
authors.forename: Micheal
authors.initials: M
authors.lastname: Quintel
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D014132:Trachea / Q000473:pathology; D016896:Treatment Outcome