Patricia Mildred Flach MD, Abstract Co-Author: Nothing to Disclose

Anders Persson MD, PhD, Abstract Co-Author: Nothing to Disclose

Sabine Franckenberg MD, Abstract Co-Author: Nothing to Disclose

Michael J. Thali MD, Abstract Co-Author: Nothing to Disclose

Steffen Ross MD, Presenter: Nothing to Disclose

Mal-positioning of a tracheal tube (TT) within the airways during intubation may lead to a serious cascade of complications, particularly in critically ill or trauma patients who require immediate emergency intubation. The purpose of this large-scale multi-center study was to identify the rate of TT-displacements of decedents on postmortem Computed Tomography (PMCT).

A total of 2312 PMCT cases from three different European Institutes of Forensic Medicine (Switzerland and Sweden) were reviewed retrospectively (2003-2014). In 208 deceased cases a TT was inserted. The median age was 52.4 years (0.1-95 years). All corpses underwent whole body PMCT (Somatom 6, Somatom 16, Somatom Definition Flash; Siemens Medical, Germany) with slice thicknesses varying from 1 to 3mm. Image analysis was performed on a CT workstation (SynGo, Multi Modality Workplace, Siemens Medical, Germany).

Of all 208 deceased with a TT, less than a third (32%) presented with a mal-positioned TT (intraglottic 7%, tracheal bifurcation 18 % supracarinal, right main bronchus 43% bronchial, left main bronchus 14%, esophageal 11%, mediastinal after tracheal rupture 7%). Retrospective analysis of the treatment protocols showed that in 73 cases the medical personal removed the TT directly after the confirmation of death.

This multicentric study shows that PMCT is a valuable, non-invasive tool in depiction of displaced tracheal tubes in deceased. An insufficient tracheal intubation may cause hypoxia and generates a significant increase in morbidity. This fact becomes a forensic key-point in the evaluation of potential medical malpractice cases. The postmortem removal of tracheal tubes may obscure a failed intubation and therefore causing a loss of forensic evidence in court. The rate of insufficient tracheal intubations shows with almost a third of all cases a slightly higher rate than in comparative clinical studies with a non-fatal outcome. This fact could be related to the severity of the life-threatening circumstances and the resulting lack of chance to verify the position of the tracheal tube in a dying patient.

Non-invasive documentation of a misplaced tracheal tube on PMCT is a key-point in the evaluation of potential medical malpractice. This is hardly detectable during autopsy without potential dislocation of the TT due to preparation.

Flach, P, Persson, A, Franckenberg, S, Thali, M, Ross, S, Mal-positioned Tracheal Tubes on Postmortem Computed Tomography in Forensic Cases.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015225.html