Misplaced and dislodged endotracheal tubes may be detected by the defibrillator during cardiopulmonary resuscitation

Abstract

We present two cases of unrecognized endotracheal tube misplacements in out-of-hospital cardiopulmonary resuscitation recognized by the analysis of transthoracic impedance. In Case 1, ventilation-induced changes in transthoracic impedance disappeared after an intubation attempt corresponding to oesophageal intubation. This was clinically recognized after several minutes, the endotracheal tube was repositioned and alterations in transthoracic impedance resumed. In Case 2, the initial ventilation-induced signal change following endotracheal intubation weakened after a few minutes. At that time, the defibrillator gave vocal and visual feedback to the rescuers on ventilatory inactivity, a pharyngeal air leak was discovered simultaneously and the tube was found to be dislodged. Continuous monitoring of transthoracic impedance provided by the defibrillator during cardiopulmonary resuscitation may contribute to the early detection of an initially misplaced or later dislodged endotracheal tube.