Marathon Participant Suffers Brain Damage Due to Mismanaged Intubation

This case involves a middle-aged woman who passed out during a marathon. EMTs responded and intubated the patient before transporting her to a nearby hospital. After arrival at the hospital, it was determined that the patient had been intubated into the esophagus. The tube was then removed and the patient’s oxygen saturation began to rise, however she had suffered significant hypoxic brain injuries. It was later determined that the patient would likely have recovered without significant medical intervention by EMTs.

Question(s) For Expert Witness

1. How often do you treat patients with similar presentations?

2. What are some methods of confirmation of endotracheal tube placement commonly used in emergency conditions?

3. To what extent does an unrecognized esophageal intubation affect the patient prognosis?

Expert Witness Response E-065721

I am an associate professor of emergency medicine at a tertiary care academic teaching Level I trauma center, that receives a lot of orthopedic patient transfers from hospitals in the quad-county region. I treat patients that have had cardiac arrest frequently, on a weekly basis. Multiple methods are available for confirmation including CXR, end tidal indicator, tube condensate, auscultation, and expired CO2 monitoring. An unrecognized esophageal intubation can affect the patient prognosis. This is dependent upon the length of time of esophageal intubation. The more time, the worst prognosis for the patient. In addition, I am also a basic science researcher in diabetic ischemia/reperfusion injury.