Accuracy of ultrasound for endotracheal intubation between different transducer types

Michael Gottlieb, Dallas Holladay, Katharine Burns, Stephen R. Gore, Collin Wulff, Shital Shah, John M Bailitz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. Methods: This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumferences. Cadavers were randomized to tracheal or esophageal intubation. Blinded sonographers assessed the location of the ETT using either a linear or curvilinear transducer in an alternating sequence. Accuracy of sonographer identification, time to identification, and operator confidence were assessed. Results: Four hundred and five assessments were performed with 198 (48.9%) tracheal and 207 (51.1%) esophageal intubations. The linear transducer was 98% (95% CI 95.1% to 99.2%) accurate. The curvilinear transducer was 95% (95% CI 91.1% to 97.3%) accurate. The mean time to identification was significantly lower with the linear transducer [7.46 s (95% CI 6.23 to 8.7 s)] as compared with the curvilinear transducer [11.63 s (95% CI 9.05 to 14.2 s)]. The mean operator confidence was significantly higher with the linear transducer [4.84/5.0 (95% CI 4.76 to 4.91)] than with the curvilinear transducer [4.44/5.0 (95% CI 4.3 to 4.57)]. All operators preferred the linear transducer over the curvilinear transducer. Conclusion: The diagnostic accuracy of ultrasound for ETT confirmation did not significantly differ between ultrasound transducer types, but the curvilinear transducer was associated with a longer time to confirmation and lower operator confidence. Further studies are needed to determine if the accuracy would change with more novice providers or in specific patient populations.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Intratracheal Intubation
Transducers
Cadaver
Intubation
Heart Arrest
Ultrasonography

Keywords

  • Curvilinear
  • Endotracheal
  • Frequency
  • Intubation
  • Linear
  • Probe
  • Transducer
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Gottlieb, Michael ; Holladay, Dallas ; Burns, Katharine ; Gore, Stephen R. ; Wulff, Collin ; Shah, Shital ; Bailitz, John M. / Accuracy of ultrasound for endotracheal intubation between different transducer types. In: American Journal of Emergency Medicine. 2019.
@article{b031840c29b44e55bde99f709b3dec63,
title = "Accuracy of ultrasound for endotracheal intubation between different transducer types",
abstract = "Introduction: Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. Methods: This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumferences. Cadavers were randomized to tracheal or esophageal intubation. Blinded sonographers assessed the location of the ETT using either a linear or curvilinear transducer in an alternating sequence. Accuracy of sonographer identification, time to identification, and operator confidence were assessed. Results: Four hundred and five assessments were performed with 198 (48.9{\%}) tracheal and 207 (51.1{\%}) esophageal intubations. The linear transducer was 98{\%} (95{\%} CI 95.1{\%} to 99.2{\%}) accurate. The curvilinear transducer was 95{\%} (95{\%} CI 91.1{\%} to 97.3{\%}) accurate. The mean time to identification was significantly lower with the linear transducer [7.46 s (95{\%} CI 6.23 to 8.7 s)] as compared with the curvilinear transducer [11.63 s (95{\%} CI 9.05 to 14.2 s)]. The mean operator confidence was significantly higher with the linear transducer [4.84/5.0 (95{\%} CI 4.76 to 4.91)] than with the curvilinear transducer [4.44/5.0 (95{\%} CI 4.3 to 4.57)]. All operators preferred the linear transducer over the curvilinear transducer. Conclusion: The diagnostic accuracy of ultrasound for ETT confirmation did not significantly differ between ultrasound transducer types, but the curvilinear transducer was associated with a longer time to confirmation and lower operator confidence. Further studies are needed to determine if the accuracy would change with more novice providers or in specific patient populations.",
keywords = "Curvilinear, Endotracheal, Frequency, Intubation, Linear, Probe, Transducer, Ultrasound",
author = "Michael Gottlieb and Dallas Holladay and Katharine Burns and Gore, {Stephen R.} and Collin Wulff and Shital Shah and Bailitz, {John M}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2019.03.016",
language = "English (US)",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

}

Accuracy of ultrasound for endotracheal intubation between different transducer types. / Gottlieb, Michael; Holladay, Dallas; Burns, Katharine; Gore, Stephen R.; Wulff, Collin; Shah, Shital; Bailitz, John M.

In: American Journal of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Accuracy of ultrasound for endotracheal intubation between different transducer types

AU - Gottlieb, Michael

AU - Holladay, Dallas

AU - Burns, Katharine

AU - Gore, Stephen R.

AU - Wulff, Collin

AU - Shah, Shital

AU - Bailitz, John M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. Methods: This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumferences. Cadavers were randomized to tracheal or esophageal intubation. Blinded sonographers assessed the location of the ETT using either a linear or curvilinear transducer in an alternating sequence. Accuracy of sonographer identification, time to identification, and operator confidence were assessed. Results: Four hundred and five assessments were performed with 198 (48.9%) tracheal and 207 (51.1%) esophageal intubations. The linear transducer was 98% (95% CI 95.1% to 99.2%) accurate. The curvilinear transducer was 95% (95% CI 91.1% to 97.3%) accurate. The mean time to identification was significantly lower with the linear transducer [7.46 s (95% CI 6.23 to 8.7 s)] as compared with the curvilinear transducer [11.63 s (95% CI 9.05 to 14.2 s)]. The mean operator confidence was significantly higher with the linear transducer [4.84/5.0 (95% CI 4.76 to 4.91)] than with the curvilinear transducer [4.44/5.0 (95% CI 4.3 to 4.57)]. All operators preferred the linear transducer over the curvilinear transducer. Conclusion: The diagnostic accuracy of ultrasound for ETT confirmation did not significantly differ between ultrasound transducer types, but the curvilinear transducer was associated with a longer time to confirmation and lower operator confidence. Further studies are needed to determine if the accuracy would change with more novice providers or in specific patient populations.

AB - Introduction: Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. Methods: This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumferences. Cadavers were randomized to tracheal or esophageal intubation. Blinded sonographers assessed the location of the ETT using either a linear or curvilinear transducer in an alternating sequence. Accuracy of sonographer identification, time to identification, and operator confidence were assessed. Results: Four hundred and five assessments were performed with 198 (48.9%) tracheal and 207 (51.1%) esophageal intubations. The linear transducer was 98% (95% CI 95.1% to 99.2%) accurate. The curvilinear transducer was 95% (95% CI 91.1% to 97.3%) accurate. The mean time to identification was significantly lower with the linear transducer [7.46 s (95% CI 6.23 to 8.7 s)] as compared with the curvilinear transducer [11.63 s (95% CI 9.05 to 14.2 s)]. The mean operator confidence was significantly higher with the linear transducer [4.84/5.0 (95% CI 4.76 to 4.91)] than with the curvilinear transducer [4.44/5.0 (95% CI 4.3 to 4.57)]. All operators preferred the linear transducer over the curvilinear transducer. Conclusion: The diagnostic accuracy of ultrasound for ETT confirmation did not significantly differ between ultrasound transducer types, but the curvilinear transducer was associated with a longer time to confirmation and lower operator confidence. Further studies are needed to determine if the accuracy would change with more novice providers or in specific patient populations.

KW - Curvilinear

KW - Endotracheal

KW - Frequency

KW - Intubation

KW - Linear

KW - Probe

KW - Transducer

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85062893789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062893789&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2019.03.016

DO - 10.1016/j.ajem.2019.03.016

M3 - Article

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -