Airway ultrasound for the confirmation of endotracheal tube placement in cadavers by military flight medic trainees – A pilot study

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Abstract

Objective

Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model.

Methods

We conducted a prospective, randomized trial in a human cadaver model. Participants received a brief didactic and hands-on presentation on airway US techniques. Each participant then performed transtracheal US on cadaver models which were randomly assigned to tracheal or esophageal intubation; time to verbalize ETT location was also recorded. Participants were then asked whether they felt airway US would be a useful adjunctive skill in their practice.

Results

Thirty-two military flight medic trainees were enrolled. US had a sensitivity of 66.7% and a specificity of 76.4% for identification of esophageal intubations. The positive predictive value was 71.4% and the negative predictive value was 72.2%. Mean time to report ETT placement was 47.3 s. Time did not vary between medics with accurate identification versus inaccurate identification (p = 0.176). 83% of participants felt airway US would be a useful adjunctive skill for the confirmation of ETT placement.

Conclusions

Military flight medic trainees can rapidly use airway US to identify ETT placement after a short educational session with moderate sensitivity and specificity. These advanced military medics are interested in learning and implementing this skill into their practice.

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