A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians

J Ultrasound Med. 2017 Oct;36(10):2079-2085. doi: 10.1002/jum.14231. Epub 2017 May 15.

Abstract

Objectives: Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation.

Methods: We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement.

Results: Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training.

Conclusions: A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position.

Keywords: airway confirmation; emergency medicine; intubation; sonography.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Competence / statistics & numerical data*
  • Cohort Studies
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Internship and Residency*
  • Intubation, Intratracheal / methods*
  • Male
  • Middle Aged
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Trachea / diagnostic imaging*
  • Ultrasonography / methods*
  • Young Adult