2090775 A Prospective Evaluation of Real-Time, Transverse Tracheal Ultrasound in the Evaluation of Emergent Intubation by Minimally Trained Practitioners

Abstract

ObjectivesThe primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation.MethodsThis was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement.ResultsTo date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%.ConclusionsWith our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations. ObjectivesThe primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation. The primary OBJECTIVES: is to determine if minimally trained Emergency Medicine resident physicians can confirm correct placement of endotracheal intubation using bedside ultrasound in real time. A secondary OBJECTIVES: will be to determine if level of training plays a role in the ability of a sonographer to determine endotracheal versus esophageal intubation. MethodsThis was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement. This was a multi-center, prospective, cohort study designed to assess the diagnostic accuracy of real-time Emergency Department (ED) bedside ultrasound in confirming position of endotracheal intubation. Patients were prospectively enrolled through the Emergency Department at both sites. Any patient in the Emergency Department requiring emergent intubation was considered for study enrollment beginning December 2013. During the intubation attempt, the sonographer was positioned at the side of the patient with the ultrasound screen facing away from the intubator. A 6 second video clip was recorded for a later review by the ultrasound director at each institution. Both immediate interpretation by ultrasound resident and retrospective video review by ultrasound director was then compared to CO2 color change, direct visualization by intubator and post procedural chest x-ray for placement. ResultsTo date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%. To date, 41 patients have been enrolled with a sensitivity of 96% and a specificity of 100%. ConclusionsWith our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations. With our results thus far, point of care ultrasound in the hands of minimally trained Emergency Medicine residents has shown great promise in accurately identifying correct placement of endotracheal tube during Emergency Department intubations.