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Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  25 August 2020

Michael Joyce ,
Jordan Tozer Open the ORCID record for Jordan Tozer [Opens in a new window] ,
Michael Vitto  and
David Evans Open the ORCID record for David Evans [Opens in a new window]
Michael Joyce
Affiliation:
Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, VirginiaUSA
Jordan Tozer*
Affiliation:
Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, VirginiaUSA
Michael Vitto
Affiliation:
Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, VirginiaUSA
David Evans
Affiliation:
Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, VirginiaUSA
*
Correspondence: Jordan Tozer, MD, FACEP, RDMS, RDCS Assistant Professor of Emergency Medicine Virginia Commonwealth University School of Medicine, Richmond, Virginia23298USA, E-mail: jordan.tozer@vcuhealth.org
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Abstract

Introduction:

The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill.

Methods:

Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed.

Results:

All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction.

Conclusions:

The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.

Keywords

ACLSintubationultrasound
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 6 , December 2020 , pp. 629 - 631
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Copyright
© World Association for Disaster and Emergency Medicine 2020

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