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The effect of sonologist experience on the ability to determine endotracheal tube location using transtracheal ultrasound.
Am J Emerg Med. 2014 Mar; 32(3):267-9.AJ

Abstract

STUDY OBJECTIVE

Transtracheal ultrasound has been described as a method to evaluate endotracheal tube placement. Correlation between sonologist experience and the successful use of transtracheal ultrasound to identify endotracheal tube location has not been examined. Our objectives were to evaluate emergency physicians' ability to correctly identify endotracheal tube location using transtracheal ultrasound and to evaluate the role operator experience plays in successful identification of tube placement.

METHODS

This was a cross-sectional, single-blinded study conducted in a cadaver laboratory. Two cadavers were used as models. One cadaver had an endotracheal tube placed in the esophagus, and the second had the tube placed in the trachea. Participants were asked to evaluate tube placement using transtracheal ultrasound and to record their interpretation. Examination clips were reviewed by the emergency ultrasound fellowship director. Descriptive statistics and χ(2) test were used for analysis.

RESULTS

Twenty-nine participants were included, 8 (27.6%) of whom were considered to be "most experienced" based on previous ultrasound experience (>150 scans). Eleven of 29 correctly identified esophageal intubation and 18 of 29 correctly identified tracheal intubation, resulting in a sensitivity of 62.0% (95% confidence interval [CI], 42.3-79.3) and a specificity of 37.9% (95% CI, 20.7-57.7). Transtracheal ultrasound performed by the most experienced sonologists showed better sensitivity and specificity, 75.0% (95% CI, 34.9-96.8) and 62.5% (95% CI, 24.5-91.5), respectively.

CONCLUSION

Most participants obtained adequate images, but correct interpretation of the images was poor. The most experienced sonologists correctly identified tube location more often. Additional education would be required before adopting this method.

Authors+Show Affiliations

Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA. Electronic address: rstuntz@wellspan.org.Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA.Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA.Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

24360314

Citation

Stuntz, Robert, et al. "The Effect of Sonologist Experience On the Ability to Determine Endotracheal Tube Location Using Transtracheal Ultrasound." The American Journal of Emergency Medicine, vol. 32, no. 3, 2014, pp. 267-9.
Stuntz R, Kochert E, Kehrl T, et al. The effect of sonologist experience on the ability to determine endotracheal tube location using transtracheal ultrasound. Am J Emerg Med. 2014;32(3):267-9.
Stuntz, R., Kochert, E., Kehrl, T., & Schrading, W. (2014). The effect of sonologist experience on the ability to determine endotracheal tube location using transtracheal ultrasound. The American Journal of Emergency Medicine, 32(3), 267-9. https://doi.org/10.1016/j.ajem.2013.11.032
Stuntz R, et al. The Effect of Sonologist Experience On the Ability to Determine Endotracheal Tube Location Using Transtracheal Ultrasound. Am J Emerg Med. 2014;32(3):267-9. PubMed PMID: 24360314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of sonologist experience on the ability to determine endotracheal tube location using transtracheal ultrasound. AU - Stuntz,Robert, AU - Kochert,Erik, AU - Kehrl,Thompson, AU - Schrading,Walter, Y1 - 2013/11/26/ PY - 2013/08/20/received PY - 2013/11/06/revised PY - 2013/11/16/accepted PY - 2013/12/24/entrez PY - 2013/12/24/pubmed PY - 2014/4/29/medline SP - 267 EP - 9 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 32 IS - 3 N2 - STUDY OBJECTIVE: Transtracheal ultrasound has been described as a method to evaluate endotracheal tube placement. Correlation between sonologist experience and the successful use of transtracheal ultrasound to identify endotracheal tube location has not been examined. Our objectives were to evaluate emergency physicians' ability to correctly identify endotracheal tube location using transtracheal ultrasound and to evaluate the role operator experience plays in successful identification of tube placement. METHODS: This was a cross-sectional, single-blinded study conducted in a cadaver laboratory. Two cadavers were used as models. One cadaver had an endotracheal tube placed in the esophagus, and the second had the tube placed in the trachea. Participants were asked to evaluate tube placement using transtracheal ultrasound and to record their interpretation. Examination clips were reviewed by the emergency ultrasound fellowship director. Descriptive statistics and χ(2) test were used for analysis. RESULTS: Twenty-nine participants were included, 8 (27.6%) of whom were considered to be "most experienced" based on previous ultrasound experience (>150 scans). Eleven of 29 correctly identified esophageal intubation and 18 of 29 correctly identified tracheal intubation, resulting in a sensitivity of 62.0% (95% confidence interval [CI], 42.3-79.3) and a specificity of 37.9% (95% CI, 20.7-57.7). Transtracheal ultrasound performed by the most experienced sonologists showed better sensitivity and specificity, 75.0% (95% CI, 34.9-96.8) and 62.5% (95% CI, 24.5-91.5), respectively. CONCLUSION: Most participants obtained adequate images, but correct interpretation of the images was poor. The most experienced sonologists correctly identified tube location more often. Additional education would be required before adopting this method. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/24360314/The_effect_of_sonologist_experience_on_the_ability_to_determine_endotracheal_tube_location_using_transtracheal_ultrasound_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(13)00812-7 DB - PRIME DP - Unbound Medicine ER -