Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis

Gottlieb, Michael; Holladay, Dallas; Peksa, Gary D.

doi:10.1016/j.annemergmed.2018.06.024

Cited by 94 publications

(65 citation statements)

References 35 publications

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“…Area under the receiver operating characteristic curve demonstrated a high degree of accuracy (area under the curve = 0.994; 95% CI = 0.982 to 0.998). The mean time to confirmation was 13.0 seconds (95% CI = 12.0 to 14.0 seconds) . Subgroup analyses demonstrated no statistically significant difference with respect to enrollment location, provider, training, transducer type, or technique.…”

Section: Narrativementioning

confidence: 88%

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Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

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heading Transtracheal ultrasound can accurately guide and verify endotracheal tube placement Positive LR findings LR+: 34 for transtracheal ultrasound confirmation of endotracheal tube placement Negative LR findings LR-: 0.01 for transtracheal ultrasound confirmation of endotracheal tube placement Who was in the studies 17 studies comprising 1,595 patients, with 12 studies conducted in the ED NARRATIVEEndotracheal intubation is a common intervention in the emergency department (ED) and prehospital setting. Direct visualization of endotracheal tube (ETT) placement through the vocal cords is limited at times, and esophageal intubation can be dangerous if not recognized. 1 Therefore, additional methods (e.g., lung auscultation, esophageal detector devices, capnography) are necessary for confirmation of tube placement. However, these methods are not always reliable. 2-4 Point-of-care ultrasonography (POCUS) has increasingly been used as a potential confirmatory tool for ETT confirmation. The 2015 Advanced Cardiac Life Support guidelines state that POCUS may be a useful adjunct for ETT confirmation. 5The meta-analysis discussed here included prospective observational or randomized controlled trials evaluating transtracheal POCUS for ETT placement confirmation in patients older than 18 years. 6 All studies included a confirmatory test for comparison (e.g. end-tidal capnography, colorimetric capnography, direct visualization). The primary outcome was diagnostic accuracy of transtracheal POCUS for ETT confirmation, with subgroup analyses including location, provider specialty, provider experience, transducer type, and POCUS technique. The authors also assessed time to confirmation as a secondary outcome.The authors of the meta-analysis identified 17 studies (n = 1,595 patients) that met their inclusion criteria. Twelve studies were performed in the ED, and five studies were conducted in the operating room. Overall, POCUS was 98.7% sensitive (95% confidence interval [CI] = 97.8% to 99.2%) and 97.1% specific (95% CI = 92.4% to 99.0%), with a positive likelihood ratio (LR+) of 34.4 (95% CI = 12.7 to 93.1) and a negative likelihood ratio (LR-) of 0.01 (95% CI = 0.01 to 0.02). Area under the receiver operating characteristic curve demonstrated a high degree of accuracy (area under the curve = 0.994; 95% CI = 0.982 to 0.998). The mean time to confirmation was 13.0 seconds (95% CI = 12.0 to 14.0 From the

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Section: Narrativementioning

confidence: 88%

“…The meta‐analysis discussed here included prospective observational or randomized controlled trials evaluating transtracheal POCUS for ETT placement confirmation in patients older than 18 years . All studies included a confirmatory test for comparison (e.g.…”

Section: Narrativementioning

confidence: 99%

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

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“…4,5 Ultrasound has been shown to be not only useful in diagnosing airway pathology but can also assist in a variety of airway procedures such as cricothyrotomy, tracheostomy, and endotracheal intubation. [6][7][8] It facilitates assessment of airway to predict difficult laryngoscopy. 9 Ultrasound has been found to be a reliable tool for confirmation of endotracheal tube placement and predicting extubation failure.…”

Section: Introductionmentioning

confidence: 99%

“…9 Ultrasound has been found to be a reliable tool for confirmation of endotracheal tube placement and predicting extubation failure. 8,10 Traditionally, cricothyrotomy is performed by palpating anatomic landmarks in the neck, and the success of this procedure is largely dependent on accurately identifying relevant anatomical landmarks (cricothyroid membrane, cricoid, and thyroid cartilages) on palpation. However, palpation of surface landmarks is not always feasible, which can result in multiple unsuccessful attempts and hypoxia in emergent situations.…”

Section: Introductionmentioning

confidence: 99%

Integration of Pre-intubation Ultrasound into Airway Management Course: A Novel Training Program

Adhikari

Situ-LaCasse

Acuña

et al. 2011

Indian Journal of Critical Care Medicine

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Objectives:To determine the feasibility of integrating pre-intubation ultrasound into airway course and assess emergency medicine (EM) residents' confidence and comfort level in using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session. Materials and methods: This is a retrospective study. Pre-intubation ultrasound training was delivered with the following ultrasound components (didactics and hands-on sessions using human models) to EM residents: (1) sonoanatomy and scanning technique to identify cricothyroid membrane and (2) pre-intubation echocardiography for recognition of acute right ventricular failure and pre-intubation hemodynamic stabilization. Results: A total of 56 EM residents participated in this study. Only 21% [95% confidence interval (CI), 10-31%] reported using ultrasound for pre-intubation hemodynamic stabilization. After the training session, 89% (95% CI, 81-97%) reported that ultrasound-based teaching increased their knowledge of pre-intubation hemodynamic stabilization compared with traditional teaching methods. On a scale of 1 (low) through 10 (high), the average comfort level for integrating ultrasound findings into medical decision making for pre-intubation hemodynamic stabilization was 6.8 (95% CI, 6.3-7.3). Seventy-nine percent (95% CI, 68-89%) reported that focused training in airway ultrasound is adequate to identify cricothyroid membrane. On a scale of 1 (low) through 10 (high), the average confidence level for identifying cricothyroid membrane using ultrasound was 6.6 (95% CI, 6.1-7.1). Conclusion: At our institution, we successfully integrated pre-intubation ultrasound into an airway course. Emergency medicine residents had a moderate level of comfort and confidence level using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session.

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“…Ultrasound (US) is a noninvasive and real‐time diagnostic tool frequently used in emergency settings. Tracheal US has been shown to confirm endotracheal intubations during advanced airway management . The characteristic image of tracheal US is a single hyperechoic air‐mucosa interface with a comet tail artifact, as well as tracheal intubations.…”

mentioning

confidence: 99%

A Potential Pitfall of Tracheal Ultrasound for the Confirmation of Endotracheal Intubations

Lien

Chang

2019

J of Ultrasound Medicine

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Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis

Cited by 94 publications

References 35 publications

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Integration of Pre-intubation Ultrasound into Airway Management Course: A Novel Training Program

A Potential Pitfall of Tracheal Ultrasound for the Confirmation of Endotracheal Intubations

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