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Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation.
Resuscitation. 2013 Dec; 84(12):1708-12.R

Abstract

OBJECTIVE

This study aimed to evaluate the accuracy of tracheal ultrasonography for assessing endotracheal tube position during cardiopulmonary resuscitation (CPR).

METHODS

We performed a prospective observational study of patients undergoing emergency intubation during CPR. Real-time tracheal ultrasonography was performed during the intubation with the transducer placed transversely just above the suprasternal notch, to assess for endotracheal tube positioning and exclude esophageal intubation. The position of trachea was identified by a hyperechoic air-mucosa (A-M) interface with posterior reverberation artifact (comet-tail artifact). The endotracheal tube position was defined as endotracheal if single A-M interface with comet-tail artifact was observed. Endotracheal tube position was defined as intraesophageal if a second A-M interface appeared, suggesting a false second airway (double tract sign). The gold standard of correct endotracheal intubation was the combination of clinical auscultation and quantitative waveform capnography. The main outcome was the accuracy of tracheal ultrasonography in assessing endotracheal tube position during CPR.

RESULTS

Among the 89 patients enrolled, 7 (7.8%) had esophageal intubations. The sensitivity, specificity, positive predictive value, and negative predictive value of tracheal ultrasonography were 100% (95% confidence interval [CI]: 94.4-100%), 85.7% (95% CI: 42.0-99.2%), 98.8% (95% CI: 92.5-99.0%) and 100% (95% CI: 54.7-100%), respectively. Positive and negative likelihood ratios were 7.0 (95% CI: 1.1-43.0) and 0.0, respectively.

CONCLUSIONS

Real-time tracheal ultrasonography is an accurate method for identifying endotracheal tube position during CPR without the need for interruption of chest compression. Tracheal ultrasonography in resuscitation management may serve as a powerful adjunct in trained hands.

Authors+Show Affiliations

Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan. Electronic address: erichaochang@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23851048

Citation

Chou, Hao-Chang, et al. "Real-time Tracheal Ultrasonography for Confirmation of Endotracheal Tube Placement During Cardiopulmonary Resuscitation." Resuscitation, vol. 84, no. 12, 2013, pp. 1708-12.
Chou HC, Chong KM, Sim SS, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84(12):1708-12.
Chou, H. C., Chong, K. M., Sim, S. S., Ma, M. H., Liu, S. H., Chen, N. C., Wu, M. C., Fu, C. M., Wang, C. H., Lee, C. C., Lien, W. C., & Chen, S. C. (2013). Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation, 84(12), 1708-12. https://doi.org/10.1016/j.resuscitation.2013.06.018
Chou HC, et al. Real-time Tracheal Ultrasonography for Confirmation of Endotracheal Tube Placement During Cardiopulmonary Resuscitation. Resuscitation. 2013;84(12):1708-12. PubMed PMID: 23851048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. AU - Chou,Hao-Chang, AU - Chong,Kah-Meng, AU - Sim,Shyh-Shyong, AU - Ma,Matthew Huei-Ming, AU - Liu,Shih-Hung, AU - Chen,Nai-Chuan, AU - Wu,Meng-Che, AU - Fu,Chia-Ming, AU - Wang,Chih-Hung, AU - Lee,Chien-Chang, AU - Lien,Wan-Ching, AU - Chen,Shyr-Chyr, Y1 - 2013/07/09/ PY - 2013/02/26/received PY - 2013/06/02/revised PY - 2013/06/18/accepted PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2014/7/31/medline KW - Advanced cardiac life support KW - Cardiopulmonary resuscitation KW - Emergencies KW - Intratracheal KW - Intubation KW - Ultrasonography SP - 1708 EP - 12 JF - Resuscitation JO - Resuscitation VL - 84 IS - 12 N2 - OBJECTIVE: This study aimed to evaluate the accuracy of tracheal ultrasonography for assessing endotracheal tube position during cardiopulmonary resuscitation (CPR). METHODS: We performed a prospective observational study of patients undergoing emergency intubation during CPR. Real-time tracheal ultrasonography was performed during the intubation with the transducer placed transversely just above the suprasternal notch, to assess for endotracheal tube positioning and exclude esophageal intubation. The position of trachea was identified by a hyperechoic air-mucosa (A-M) interface with posterior reverberation artifact (comet-tail artifact). The endotracheal tube position was defined as endotracheal if single A-M interface with comet-tail artifact was observed. Endotracheal tube position was defined as intraesophageal if a second A-M interface appeared, suggesting a false second airway (double tract sign). The gold standard of correct endotracheal intubation was the combination of clinical auscultation and quantitative waveform capnography. The main outcome was the accuracy of tracheal ultrasonography in assessing endotracheal tube position during CPR. RESULTS: Among the 89 patients enrolled, 7 (7.8%) had esophageal intubations. The sensitivity, specificity, positive predictive value, and negative predictive value of tracheal ultrasonography were 100% (95% confidence interval [CI]: 94.4-100%), 85.7% (95% CI: 42.0-99.2%), 98.8% (95% CI: 92.5-99.0%) and 100% (95% CI: 54.7-100%), respectively. Positive and negative likelihood ratios were 7.0 (95% CI: 1.1-43.0) and 0.0, respectively. CONCLUSIONS: Real-time tracheal ultrasonography is an accurate method for identifying endotracheal tube position during CPR without the need for interruption of chest compression. Tracheal ultrasonography in resuscitation management may serve as a powerful adjunct in trained hands. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/23851048/Real_time_tracheal_ultrasonography_for_confirmation_of_endotracheal_tube_placement_during_cardiopulmonary_resuscitation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(13)00341-9 DB - PRIME DP - Unbound Medicine ER -