Aspiration of gastric contents: association with prehospital intubation

We prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. Tracheal aspirates were then tested for the presence of pepsin, a sensitive and specific marker of gastric contents, using a fibrinogen digestion technique. Over 8 months, 168 patients were enrolled. The pepsin assay was positive in 10 of 20 (50%) patients intubated in the PH group, as opposed to 33 of 148 (22%) of those intubated in the ED (chi2 P=.008; odds ratio, 3.5; 95% CI, 1.34-9.08). Patients endotracheally intubated in the PH setting are more likely to have aspirated gastric contents than those intubated in the ED.