The authors’ goal was to determine the rate at which emergency physicians document confirmation of endotracheal tube (ET) placement. The study was conducted in a 60 000-visit emergency department (ED) of an urban tertiary referral hospital. The authors’ airway registry database was used to identify patients requiring airway management; 433 patients met study criteria, 281 (65%) were intubated in the ED, and 152 (35%) were intubated prior to arrival. ET confirmation was documented for 270 (96%) patients intubated in the ED and 52 (34%) patients intubated before arrival (P < .0001).The rate was higher for patients intubated by emergency medical services (40/64 [63%]) than for interhospital transfers (12/88 [14%]) (P < .0001). Documentation of ET placement has implications for patient care and safety. This study indicates that educational interventions are warranted to improve physicians’ awareness of the importance of documenting correct tube placement.
Gausche M., Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA. 2000;283:783-790.
2.
Krisanda TJ, Eitel DR, Hess D., Ormanoski R., Bernini R., Sabulsky N.An analysis of invasive airway management in a suburban emergency medical services system. Prehosp Disaster Med. 1992 ;7:121-126.
3.
Wang HE, Cupas DF, Hostler D., Crooney R., Yealy DM, Lave JRProcedural experience with out-of-hospital endotracheal intubation. Crit Care Med. 2005;33:1718-1721.
4.
American College of Emergency Physicians.Practice resource: verification of endotracheal tube placement. http://www.acep.org/practres.aspx?id=29940. Accessed May 29, 2010.
5.
American Heart Association International Consensus Conference.Part 4: advanced life support. Circulation. 2005;112:III-27-III-28.
6.
Wang HE, Yealy DMOut-of-hospital endotracheal intubation: where are we? Ann Emerg Med. 2006;47:532-541.
7.
Jones JH, Murphy MP, Dickson RL, Somerville GG, Brizendine EJEmergency physician-verified out-of-hospital intubation: miss rates by paramedics . Acad Emerg Med. 2004;11:707-709.
8.
Katz SH, Falk JLMisplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med. 2001;37:32-37.
9.
Brownstein D. , Shugerman R., Cummings P., Rivara F., Copass M.Prehospital endotracheal intubation of children by paramedics. Ann Emerg Med. 1996;28:34-39.
10.
Stiell IG, Wells GA, Field B., et al. Advanced cardiac life support in out-of-hospital cardiac arrest . N Engl J Med. 2004;351:647-656.
11.
Strote J., Roth R., Cone D., Wang HEPrehospital endotracheal intubation: the controversy continues. Am J Emerg Med. 2009;27:1142-1147.
12.
Sayah AJ, Peacock WF, Overton DTEnd-tidal C02 measurement in the detection of esophageal intubation during cardiac arrest. Ann Emerg Med. 1990;19:857-860.
13.
Hayden SR, Sciammarella J., Viccelio P., Thode H., Delagi R.Colorimetric end-tidal C02 detector for verification of endotracheal tube placement in out-of-hospital cardiac arrest. Acad Emerg Med . 1995;2:499-502.
14.
Kelly JJ, Eynon CA, Kaplan JL, de Garavilla L., Dalsey C.The use of tube condensation as an indicator of endotracheal tube placement . Ann Emerg Med. 1998;31:575-578.
15.
Andersen KH, Hald A.Assessing the position of the endotracheal tube: the reliability of different methods. Anaesthesia. 1989;44:984-985.
16.
Pollard BJ, Junius F.Accidental intubation of the oesophagus. Anaesth Intensive Care. 1980;8:183-186.
17.
Lang DJ, Wafai Y., Salem MR, Czinn EA, Halim AA, Baraka A.Efficacy of the self-inflating bulb in confirming tracheal intubation in the morbidly obese. Anesthesiology. 1996;85:246-253.
18.
Williams KN , Nunn JFThe esophageal detector device: a prospective trial on 100 patients. Anesthesia. 1989;44:412-414.
19.
Ardagh M., Moodie K.The esophageal detector device can give false positives for tracheal intubation . J Emerg Med. 1998;16:747-749.
20.
Delbridge TR , Yealy DM"A" is for airway . . . also for action. Ann Emerg Med. 2001;37:62-64.
21.
American Society of Anesthesiologists.Standards for basic anesthetic monitoring. http://www.asahq.org/publicationsAndServices/standards/02.pdf . Accessed June 13, 2010.
22.
Winton J., Celenza A., Jackson T.Improving documentation of endotracheal intubation in an adult emergency department . Emerg Med Australas. 2008;20:488-493.
23.
Ma OJ, Bentley B II, Debehnke DJAirway management practices in emergency medicine residencies. Am J Emerg Med. 1995;13:501-504.
24.
National Quality Forum.National voluntary consensus standards for emergency care. http://www.qualityforum.org/Publications/2009/09/National_Voluntary_Consensus_Standards_for_Emergency_Care.aspx . Accessed May 29, 2010.
25.
Walls RM, Vissers RJ, Sagarin M., et al. Emergency department intubations: first report of the ongoing National Emergency Airway Registry (NEAR 97) [abstract]. Ann Emerg Med.1999;34:S14.
26.
Walls RM, Vissers RJ, Sagarin MJ1288 Emergency department intubations: final report of the National Emergency Airway Pilot Project. Acad Emerg Med. 1998 ;5:393-394.
27.
The National Emergency Airway Registry, NEAR III. http://www.near.edu. Accessed June 13, 2010.
28.
Phelan MP, Glauser J., Yuen HW, et al. Airway registry: a performance improvement surveillance project of emergency department airway management. Am J Med Qual. 2010;25:346-350.
29.
Wears RLThe chart is dead: long live the chart. Ann Emerg Med. 2008;52:390-391.
