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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Tracheal intubation in the prehospital setting has been associated with increased risk for aspiration. Using data from an ongoing study, we evaluated tracheal intubation variables with tracheal amylase and pepsin A (aspiration), and ventilatorassociated conditions (VAC). We hypothesized that subjects intubated in the field would have higher rates of aspiration and VAC. Methods: Intubation and outcome data were collected as part of an ongoing oral suction trial in ventilated patients. Consent was obtained from patient or legal proxy. Adult subjects (≥ 18) were enrolled within 24 hours of oral intubation and followed while intubated, up to 14 days. Documented aspiration at time of intubation was an exclusion criterion. Primary outcomes were tracheal amylase and VAC (NHSN criteria). Tracheal pepsin A values were evaluated in a subset (n = 84). Data were analyzed with chi-square and ANOVA. Results: Data were analyzed from 368 subjects: mean age 57.7 (18.7) years, 56.3% male, 74.2% white, 19.3% Hispanic. Intubation location was study site (82.9%), other hospital (9.2%), and field (7.9%). The ICU (39.9%) and ED (37.8%) were the most common units. Most patients (76.4%) had a positive amylase (≥ 396 IU/L) while 16.7% had a positive pepsin A (≥ 6 ng/mL) in baseline tracheal specimens. Although not significant, mean tracheal amylase values were highest for field intubations (p = 0.64); mean tracheal pepsin A values were highest for intubations at the study site (p = .61) and if more than one intubation attempt was required (p = .11). VAC rates were significantly higher for other hospital intubations (29.4%) compared with study site (11.1%) or field (10.3%, p = 0.009), and for those that required more than one intubation attempt (21.3% vs 10.0%; p = .02). Conclusions: Aspiration of oral and gastric contents was observed despite exclusion criterion of no documented aspiration during intubation. Strategies to ensure successful intubation with one attempt are needed. Further research is warranted to identify clinical implications of aspiration and explore VAC rates associated with interhospital transfers. (1R01NR014508)