Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians.

Jordan Chenkin,Colin J L Mccartney,Glen Bandiera,Tomislav Jelic,Michael Romano,Claire Heslop

doi:10.1186/s13089-015-0031-7

Abstract

BackgroundUnrecognized esophageal intubations are associated with significant patient morbidity and mortality. No single confirmatory device has been shown to be 100 % accurate at ruling out esophageal intubations in the emergency department. Recent studies have demonstrated that point-of-care ultrasound (POCUS) may be a useful adjunct for confirming endotracheal tube placement; however, the amount of practice required to become proficient at this technique is unclear. The purpose of this study is to determine the amount of practice required by emergency physicians to become proficient at interpreting ultrasound video clips of esophageal and endotracheal intubations.MethodsEmergency physicians and emergency medicine residents completed a baseline interpretation test followed by a 10 min online tutorial. They then interpreted POCUS clips of esophageal and endotracheal intubations in a randomly selected order. If an incorrect response was provided, the participant completed another practice session with feedback. This process continued until they correctly interpreted ten consecutive ultrasound clips. Descriptive statistics were used to summarize the data.ResultsOf the 87 eligible physicians, 66 (75.9 %) completed the study. The mean score on the baseline test was 42.9 % (SD 32.7 %). After the tutorial, 90.9 % (60/66) of the participants achieved proficiency after one practice attempt and 100 % achieved proficiency after two practice attempts. Six intubation ultrasound clips were misinterpreted, for a total error rate of 0.9 % (6/684). Overall, the participants had a sensitivity of 98.3 % (95 % CI 96.3–99.4 %) and specificity of 100 % (95 % CI 98.9–100 %) for detecting correct tube location. Scans were interpreted within an average of 4 s (SD 2.9 s) of the intubation.ConclusionsAfter a brief online tutorial and only two practice attempts, emergency physicians were able to quickly and accurately interpret ultrasound intubation clips of esophageal and endotracheal intubations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-015-0031-7) contains supplementary material, which is available to authorized users.

Highlights

Unrecognized esophageal intubations are associated with significant patient morbidity and mortality
Using the principles of effective Web-based educational material development, we developed an online educational module covering the technique of using ultrasound for confirming endotracheal intubation [17]
All six participants were successful after the second practice session, and no participants required more than two practice attempts

Summary

Introduction

Unrecognized esophageal intubations are associated with significant patient morbidity and mortality. Recent studies have demonstrated that point-of-care ultrasound (POCUS) may be a useful adjunct for confirming endotracheal tube placement; the amount of practice required to become proficient at this technique is unclear. The purpose of this study is to determine the amount of practice required by emergency physicians to become proficient at interpreting ultrasound video clips of esophageal and endotracheal intubations. Chenkin et al Crit Ultrasound J (2015) 7:14 device has been shown to be 100 % accurate in all patient scenarios; emergency physicians should consider the use of multiple confirmation techniques to reduce the risk of an unrecognized esophageal intubation. The objective of this study is to determine the amount of practice required by emergency physicians to achieve proficiency with interpretation of POCUS video clips of endotracheal tube placement

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Conclusion