Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation

Study objectives: To confirm the ability of the esophageal detector device (EDD) to indicate positioning of endotracheal tubes (ETTs) in patients intubated under emergency conditions and to compare the performance of the EDD with that of end-tidal carbon dioxide (ETCO₂). Methods: This single- subject study comprising a prospective case series was conducted in the emergency department of an urban university hospital. All adult patients were intubated either in the ED or by paramedics in the field. ETT position was initially evaluated by means of auscultation, then EDD, and, finally, spectrographic qualitative ETCO₂ monitoring in each patient. Discrepancies between the EBB and ETCO₂ results were resolved by means of direct laryngoscopy. Results: In 100 intubated patients, both the EDD and ETCO₂ monitoring detected the single esophageal intubation that occurred. Of the remaining 99 tracheal intubations, the EDD correctly indicated tracheal placement in 98 (sensitivity, 99%) and was indeterminate in 1 case because of blockage of the ETT by secretions resulting from pulmonary edema. By comparison, ETCO₂ monitoring correctly indicated tracheal placement in 86 cases (sensitivity, 87%) and was incorrect in 13 cases (P<.01). ETCO₂ monitoring failed in 2 patients with pulmonary edema and in 11 patients with cardiac arrest. Among the 37 patients in the cardiac arrest group, the EDD correctly indicated ETT placement in 37 patients (sensitivity, 100%). In contrast, ETCO₂ monitoring correctly indicated ETT placement in 26 patients (sensitivity, 70%; P<.01). Conclusion: The EDD reliably confirms tracheal intubation in the emergency patient population. The EDD is more accurate than ETCO₂ monitoring in the overall emergency patient population because of its greater accuracy in cardiac arrest patients.