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LETTER TO THE EDITOR

Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians

Department of Anesthesiology; VA Boston Healthcare System and Massachusetts General Hospital; Harvard Medical School; Boston, Massachusetts; kbleissner{at}yahoo.com

To the Editor:

The major finding of the recent paper by Timmermann et al. (1) study was that the incidence of unrecognized esophageal intubation performed by primary emergency physicians is frequent and is associated with a high mortality in out-of-hospital intubations. In addition, the authors emphasize the need for emergency physicians to receive continuing training in airway management and to use confirmatory adjuncts to determine endotracheal tube position.

Colorimetric end-tidal carbon dioxide detectors have a high sensitivity and specificity to accurately diagnose tracheal intubation (2). Furthermore, monitoring end-tidal carbon dioxide has been shown to be helpful in assessing adequacy of cardiopulmonary resuscitation (3) are simple to use and inexpensive. In addition to textbooks, resources for training on use of these devices can be found on the Internet (4).

Footnotes

Dr. Timmerman does not wish to respond.

REFERENCES

1. Timmermann A, Russo SG, Eich C, Roessler M, Braun U, Rosenblatt WH, Quintel M. The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 2007;104:619–23[Abstract/Free Full Text]
2. Menegazzi JJ, Heller MB. Endotracheal tube confirmation with colorimetric CO₂ detectors. Anesth Analg 1990;71:441–2[Free Full Text]
3. Nakatani K, Yukioka H, Fujimori M, Maeda C, Noguchi H, Ishihara S, Yamanaka I, Tase C. Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation. Am J Emerg Med 1999;17:203–6[Web of Science][Medline]
4. Capnography in "Out of hospital settings"-911. Available on-line at: www.capnography.com. Accessed March 12, 2007

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