Evaluating the incidence of unrecognised oesophageal intubation by paramedics

Objective: To determine the incidence of unrecognized oesophageal intubation by paramedics in a metropolitan setting. Methods: A retrospective observational analysis was conducted. Patient health care records from the Ambulance Service of New South Wales were used to identify patients who had been intubated by paramedics between 1 January 2007 and 31 December 2010, and transported to St George Hospital, Sydney. Medical records from St George Hospital were reviewed to determine the position of the endotracheal tube (ETT) on arrival in the Emergency Department. Results: During the study period, 196 patients were identified as having an ETT in-situ on arrival to the emergency department. There was inadequate documentation for 67 patients to determine ETT placement. Of the 129 patients included in the final analysis, 4 (3.1%, 95% confidence interval (CI) 0.9-7.8%) had an unrecognized oesophageal intubation. The final ETT positions of the remaining 125 patients were 85.3% (95% CI 78-90.9%) located in the trachea, 10.1% (95% CI 5.5-16.6%) located in a primary bronchus, 0.8% (95% CI 0-4.2%) in the larynx and 0.8% (95% CI 0-4.2%) in the pharynx. Conclusion: The incidence of unrecognized oesophageal intubations in this study was consistent with other reports in the literature, although higher than expected given the training and equipment used in this setting. An incidence of unrecognized oesophageal intubations of zero should be the goal of emergency medical services. The incidence of unrecognized oesophageal intubations may be reduced through recursive training programs and the use of quantitative waveform capnography.