Avir Mitra1, Asaf Gave2, Kelsey Coolahan1, Thomas Nguyen1. 1. Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine, New Jersey 08043, USA. 2. Department of Surgery Critical Care, Mount Sinai Beth Israel, Icahn School of Medicine, New York 10009, USA.
Abstract
BACKGROUND: Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED). Direct and adjunct strategies exist, but each has limitations and there is no definitive gold standard. The utility of bronchoscopy in ED intubation has been studied, but scant literature exists on its use for ET tube confirmation. This study aims to assess effectiveness, ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy. METHODS: Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable, flexible Ambu aScope interfaced with a monitor. With residents blinded, the researcher randomly placed the ET tube in the trachea, esophagus or right mainstem. Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy. Each resident underwent 4 trials. Accuracy, speed and perceptions of difficulty were measured. RESULTS: Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%). The median time-to-guess was 7.0 seconds, IQR (5.0-10.0). Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult). No tubes were damaged or dislodged. CONCLUSION: While simulation cannot completely replicate the live experience, fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation. Further studies directly comparing this novel approach to established practices on actual patients are warranted.
BACKGROUND: Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED). Direct and adjunct strategies exist, but each has limitations and there is no definitive gold standard. The utility of bronchoscopy in ED intubation has been studied, but scant literature exists on its use for ET tube confirmation. This study aims to assess effectiveness, ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy. METHODS: Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable, flexible Ambu aScope interfaced with a monitor. With residents blinded, the researcher randomly placed the ET tube in the trachea, esophagus or right mainstem. Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy. Each resident underwent 4 trials. Accuracy, speed and perceptions of difficulty were measured. RESULTS: Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%). The median time-to-guess was 7.0 seconds, IQR (5.0-10.0). Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult). No tubes were damaged or dislodged. CONCLUSION: While simulation cannot completely replicate the live experience, fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation. Further studies directly comparing this novel approach to established practices on actual patients are warranted.
Authors: J P Ornato; J B Shipley; E M Racht; C M Slovis; K D Wrenn; P E Pepe; S L Almeida; V F Ginger; T V Fotre Journal: Ann Emerg Med Date: 1992-05 Impact factor: 5.721
Authors: Melissa L Langhan; Beth L Emerson; Sholeen Nett; Matthew Pinto; Ilana Harwayne-Gidansky; Kyle J Rehder; Conrad Krawiec; Keith Meyer; John S Giuliano; Erin B Owen; Keiko M Tarquinio; Ron C Sanders; Michael Shepherd; Gokul Kris Bysani; Asha N Shenoi; Natalie Napolitano; Sandeep Gangadharan; Simon J Parsons; Dennis W Simon; Vinay M Nadkarni; Akira Nishisaki Journal: Pediatr Crit Care Med Date: 2018-02 Impact factor: 3.624
Authors: Salvatore Silvestri; Jay G Ladde; James F Brown; Jesus V Roa; Christopher Hunter; George A Ralls; Linda Papa Journal: Resuscitation Date: 2017-01-19 Impact factor: 5.262
Authors: Jung-In Ko; Sang Ook Ha; Min Seok Koo; Miyoung Kwon; Jieun Kim; Jin Jeon; So Hee Park; Sangwoo Shim; Youjin Chang; Taejin Park Journal: Clin Exp Emerg Med Date: 2015-12-28