PMID- 23851048
OWN - NLM
STAT- MEDLINE
DCOM- 20140730
LR  - 20220321
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 84
IP  - 12
DP  - 2013 Dec
TI  - Real-time tracheal ultrasonography for confirmation of endotracheal tube 
      placement during cardiopulmonary resuscitation.
PG  - 1708-12
LID - S0300-9572(13)00341-9 [pii]
LID - 10.1016/j.resuscitation.2013.06.018 [doi]
AB  - 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.
CI  - Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved.
FAU - Chou, Hao-Chang
AU  - Chou HC
AD  - Department of Emergency Medicine, National Taiwan University Hospital, Taipei 
      City, Taiwan. Electronic address: erichaochang@gmail.com.
FAU - Chong, Kah-Meng
AU  - Chong KM
FAU - Sim, Shyh-Shyong
AU  - Sim SS
FAU - Ma, Matthew Huei-Ming
AU  - Ma MH
FAU - Liu, Shih-Hung
AU  - Liu SH
FAU - Chen, Nai-Chuan
AU  - Chen NC
FAU - Wu, Meng-Che
AU  - Wu MC
FAU - Fu, Chia-Ming
AU  - Fu CM
FAU - Wang, Chih-Hung
AU  - Wang CH
FAU - Lee, Chien-Chang
AU  - Lee CC
FAU - Lien, Wan-Ching
AU  - Lien WC
FAU - Chen, Shyr-Chyr
AU  - Chen SC
LA  - eng
PT  - Journal Article
DEP - 20130709
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
CIN - Resuscitation. 2013 Dec;84(12):1641-2. PMID: 24103234
CIN - Resuscitation. 2014 Jan;85(1):e5. PMID: 24107648
CIN - Resuscitation. 2014 Jan;85(1):e7. PMID: 24107649
CIN - Resuscitation. 2014 Jan;85(1):e9. PMID: 24128797
CIN - Resuscitation. 2014 Jan;85(1):e11. PMID: 24128799
MH  - Adult
MH  - Advanced Cardiac Life Support
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiopulmonary Resuscitation/*methods
MH  - *Computer Systems
MH  - Emergencies
MH  - Female
MH  - Humans
MH  - Intubation, Intratracheal/*methods
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Sensitivity and Specificity
MH  - Trachea/*diagnostic imaging
MH  - Ultrasonography
OTO - NOTNLM
OT  - Advanced cardiac life support
OT  - Cardiopulmonary resuscitation
OT  - Emergencies
OT  - Intratracheal
OT  - Intubation
OT  - Ultrasonography
EDAT- 2013/07/16 06:00
MHDA- 2014/07/31 06:00
CRDT- 2013/07/16 06:00
PHST- 2013/02/26 00:00 [received]
PHST- 2013/06/02 00:00 [revised]
PHST- 2013/06/18 00:00 [accepted]
PHST- 2013/07/16 06:00 [entrez]
PHST- 2013/07/16 06:00 [pubmed]
PHST- 2014/07/31 06:00 [medline]
AID - S0300-9572(13)00341-9 [pii]
AID - 10.1016/j.resuscitation.2013.06.018 [doi]
PST - ppublish
SO  - Resuscitation. 2013 Dec;84(12):1708-12. doi: 10.1016/j.resuscitation.2013.06.018. 
      Epub 2013 Jul 9.