The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians

Anesth Analg. 2007 Mar;104(3):619-23. doi: 10.1213/01.ane.0000253523.80050.e9.


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.

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Emergency Medical Services*
  • Emergency Medical Technicians
  • Emergency Service, Hospital
  • Emergency Treatment / methods*
  • Female
  • Humans
  • Intubation / methods*
  • Intubation, Intratracheal / methods*
  • Male
  • Medical Errors
  • Middle Aged
  • Trachea / pathology
  • Treatment Outcome