Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study

• Published in: The American journal of emergency medicine 2018-11, Vol.36 (11), p.1943-1946
• Main Authors: Sanri, Erkman, Akoglu, Ebru Unal, Karacabey, Sinan, Verimli, Ural, Akoglu, Haldun, Sehirli, Umit, Denizbasi, Arzu
• Format: Article
• Language: English
• Subjects: Accuracy; Borescope; Cadaver; Cameras; Emergency medical care; Endoscopes; Endoscopy; Endotracheal intubation; Esophagus; Fiberoptic bronchoscopy; Intubation; Medical diagnosis; Medical instruments; Optical fibers; Respiratory tract; Software; Studies; Trachea; Tracheal ultrasonography; Ultrasonic imaging; Ultrasound; USB-endoscopy
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.02.015

Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera. This study was conducted in the Anatomy Lab of a University on a fresh frozen female cadaver. Three senior Emergency Physicians have intubated the cadaver, and performed TUS or USB-endoscopy. We have prepared a randomized intubation list (n=96) in three blocks (3 times 32) as to include equal number of esophageal and tracheal intubations (48 for each). Each EP is performed all three interventions (intubation, TUS and USB-endoscopy) in consecutive blocks of 32 intubations, in turn. The position of the tube has been verified from a 2cm wide ostium on the proximal trachea. In this study, all intubations (n=96, 100%) were correctly identified as tracheal or esophageal with both TUS and USB-camera. Both the sensitivity and specificity of TUS and USB-endoscopy for the CoETP were 100.0%. The perfect accuracy of TUS and USB-endoscopy, have placed those techniques in a unique position as an alternative in resource-poor situations.