Confi rmation of endotracheal tube placement using disposable fi beroptic bronchoscopy in the emergent setting

Avir Mitra, Asaf Gave, Kelsey Coolahan, Thomas Nguyen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

BACKGROUND: Patients intubated in the prehospital setting require quick and definitive confi rmation 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 defi nitive gold standard. The utility of bronchoscopy in ED intubation has been studied, but scant literature exists on its use for ET tube confi rmation. This study aims to assess effectiveness, ease and speed with which ET tube placement can be confi rmed with disposable fi beroptic 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, fl exible Ambu aScope interfaced with a monitor. With residents blinded, the researcher randomly placed the ET tube in the trachea, esophagus or right mainstem. Residents identifi ed ET tube position by threading the bronchoscope through the tube and viewing distal anatomy. Each resident underwent 4 trials. Accuracy, speed and perceptions of diffi culty were measured. RESULTS: Residents accurately identifi ed 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 diffi cult). 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 confi rmation. Further studies directly comparing this novel approach to established practices on actual patients are warranted.

Original languageEnglish
Pages (from-to)210-214
Number of pages5
JournalWorld Journal of Emergency Medicine
Volume10
Issue number4
DOIs
StatePublished - 2019

Keywords

  • Airway
  • Bronchoscopy
  • Simulation
  • Tube confi rmation

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