Re: Denver Airway Study (Just Released in OEC)

June 5, 2009

What doesn't seem to be mentioned is whether ETCO2 monitoring was in use.

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Denver Airway Study (Just Released in OEC)

Abstract

Objectives. To determine 1) the success rate of prehospital endotracheal

intubation; 2) the unrecognized tube malposition rate; and 3) predictors of

tube malposition upon arrival to the emergency department (ED) in the

setting of a large metropolitan area that includes 18 hospitals and 34

transporting emergency medical services (EMS) agencies. Methods. Prospective

data were collected on patients for whom prehospital intubation was

attempted between September 1, 2004, and January 31, 2005. Endotracheal tube

(ETT) position upon arrival to the ED was verified by emergency medicine

attending physicians. Missing cases were identified by matching prospective

data with lists of attempted intubations submitted by EMS agencies, and data

were obtained for these cases by retrospective chart review. Successful

intubation was defined as an ³endotracheal tube balloon below the cords² on

arrival to the ED. Patients were the unit of analysis; proportions with 95%

confidence intervals were calculated. Results. Nine hundred twenty-six

patients had an attempted intubation. Methods of airway management were

determined for 97.5% (825/846) of those transported to a hospital and 33.8%

(27/80) of those who died in the field. For transported patients, 74.8% were

successfully intubated, 20% had a failed intubation, 5.2% had a

malpositioned tube on arrival to the ED, and 0.6% had another method of

airway management used. Malpositioned tubes were significantly more common

in pediatric patients (13.0%, compared with 4.0% for nonpediatric patients).

Conclusions. Overall intubation success was low, and consistent with

previously published series. The frequency of malpositioned ETT was

unacceptably high, and also consistent with prior studies. Our data support

the need for ongoing monitoring of EMS providers' practices of endotracheal

intubation.

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