ESOPHAGEAL DETECTOR DEVICE VERSUS DETECTION OF END-TIDAL CARBON-DIOXIDE LEVEL IN EMERGENCY INTUBATION

Study objectives:To confirm the ability of the esophageal detector dev ice (EDD) to indicate positioning of endotracheal tubes (ETTs) in pati ents intubated under emergency conditions and to compare the performan ce of the EDD with that of endtidal carbon dioxide (ETco(2)). Methods: This single-subject study comprising a prospective case series was co nducted in the emergency department of an urban university hospital. A ll adult patients were intubated either in the ED or by paramedics in the field. ETT position was initially evaluated by means of auscultati on, then EDD, and, finally, spectrographic qualitative ETco(2) monitor ing in each patient. Discrepancies between the EDD and ETco(2) results were resolved by means of direct laryngoscopy. Results: In 100 intuba ted patients, both the EDD and ETco(2) monitoring detected the single esophageal intubation that occurred. Of the remaining 99 tracheal intu bations, the EDD correctly indicated tracheal placement in 98 (sensiti vity, 99%) and was indeterminate in 1 case because of blockage of the Err by secretions resulting from pulmonary edema. By comparison, ETco( 2) monitoring correctly indicated tracheal placement in 86 cases (sens itivity, 87%) and was incorrect in 13 cases (P<.01). ETco(2) monitorin g failed in 2 patients with pulmonary edema and in 11 patients with ca rdiac arrest. Among the 37 patients in the cardiac arrest group. the E DD correctly indicated ETT placement in 37 patients (sensitivity, 100% ). In contrast, ETco(2) monitoring correctly indicated ETT placement i n 26 patients (sensitivity, 70%; P<.01). Conclusion: The EDD reliably confirms tracheal intubation in the emergency patient population. The EDD is more accurate than ETco(2) monitoring in the overall emergency patient population because of its greater accuracy in cardiac arrest p atients.