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18C/GS 0602 · 07-19-2004, 12:07

This article came out in Academic Emergency Medicine this June. In the discussion section they talk about a study by Katz et al 2001 done in Orlando (the same one that ccrn cited) that showed a miss rate of 25%. A follow up to the Katz study by the same authors showed a decrease in miss rates from 25% to 9% after the implementation of protocols that required ET CO2 detection devices. They also showed that in a subset of paramedics that had 100% compliance with the ET CO2 monitoring they had a 0% miss rate.

Emergency Physician–Verified Out-of-hospital Intubation: Miss Rates by Paramedics
James H. Jones, MD, Michael P. Murphy, MD, Robert L. Dickson, MD, Geoff G. Somerville, BS, EMT-P and Edward J. Brizendine, MS

-ABSTRACT

Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department.

07-19-2004, 12:07	#40
18C/GS 0602 Quiet Professional Join Date: Jan 2004 Location: Pineland Posts: 74	This article came out in Academic Emergency Medicine this June. In the discussion section they talk about a study by Katz et al 2001 done in Orlando (the same one that ccrn cited) that showed a miss rate of 25%. A follow up to the Katz study by the same authors showed a decrease in miss rates from 25% to 9% after the implementation of protocols that required ET CO2 detection devices. They also showed that in a subset of paramedics that had 100% compliance with the ET CO2 monitoring they had a 0% miss rate. Emergency Physician–Verified Out-of-hospital Intubation: Miss Rates by Paramedics James H. Jones, MD, Michael P. Murphy, MD, Robert L. Dickson, MD, Geoff G. Somerville, BS, EMT-P and Edward J. Brizendine, MS -ABSTRACT Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department.
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