Lights and Siren Versus No Lights and Siren: Ambulance Transport Time from the Scene to the Emergency Department

Abstract

The esophageal detector device (EDD) recently has been found to assess endotracheal (ET) tube placement accurately. This study determined the reliability of the EDD in determining ET tube position in difficult clinical airway situations. Methods: This study was a prospective, randomized, singleblinded, controlled, laboratory investigation. Two airway managers (an Emergency Medicine attending physician and resident) determined ET tube placement using the EDD in five anesthetized swine (average weight = 23.5 kg) in respiratory arrest. The ET tube was placed in the following clinical airway situations: esophagus, esophagus with 1 liter of air instilled, trachea, trachea with 5 cc/kg water instilled, and right tracheal mainstem. Anatomic location of the tube was verified by left chest thoracotomy. Results: There was 100% agreement between the resident and attending physician's use of the EDD. The EDD was 100% accurate in determining tube placement in esophageal, esophageal with 1 L of air instilled, tracheal, and right mainstem intubations. The airway managers were only 80% accurate in detecting tracheal intubations when fluid was present. Conclusions: The EDD is an accurate and reliable device for detecting ET tube placement in most clinical situations. Tube placement in fluid filled trachea/lungs, which occurs in pulmonary edema and drowning, may not be detected. This simple device may be useful in the emergency medical services (EMS) setting.