Assessment of endotracheal intubation procedures following inadvertent esophageal intubation. A randomized crossover manikin trial

AbstractHypothesis:Advanced airway intervention techniques are being considered for use by basic emergency medical technicians (EMTs). It was hypothesized that basic EMTs would be able to discriminate reliably between intratracheal and esophageal endotracheal tube, placement in a mannequin model.Design:An airway mannequin with a closed chest cavity was intubated randomly either esophageally or tracheally, and the cuff was inflated. A stethoscope, bag ventilator, and laryngoscope were available next to the mannequin. Placement was assessed by auscultation or direct visualization at the discretion of the EMT. A blinded investigator graded the student.Setting:A classroom in a large, urban medical center.Participants:Subjects were basic EMTs who volunteered to take part after the conclusion of a six-hour endotracheal intubation training course.Results:Thirty-three subjects were tested. Seventeen of 18 (94%) tracheal intubations and 11 of 15 (73%) esophageal intubations were identified correctly. Only 72% of the students listened to the epigastrium, 81% listened to the lungs, and 85% attempted ventilation. The 10 students who visualized the cords discovered all five esophageal intubations. The 23 students who did not visualize the cords missed four and found six esophageal intubations.Conclusion:Basic EMTs had difficulty assessing endotracheal tube placement in a mannequin model. The 27% miss rate for identifying esophageal intubations suggests that basic EMTs will require additional training for safe field use of any airway that requires assessment of tube placement.

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Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2014.07.004 ◽

2015 ◽

Vol 27 (2) ◽

pp. 168-169 ◽

Cited By ~ 3

Author(s):

Khaled Sorour ◽

Lucas Donovan

Keyword(s):

Case Report ◽

Endotracheal Intubation ◽

Esophageal Intubation

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Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices

PLoS ONE ◽

10.1371/journal.pone.0260140 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260140

Author(s):

Dóra Keresztes ◽

Ákos Mérei ◽

Martin Rozanovic ◽

Edina Nagy ◽

Zoltán Kovács-Ábrahám ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Difficult Airway ◽

Success Rate ◽

Endotracheal Intubation ◽

Macintosh Laryngoscope ◽

Dental Trauma ◽

Esophageal Intubation ◽

Successful Intubation ◽

Normal Airway ◽

Novice Users

Introduction Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. Materials and methods Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. Results In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. Conclusion All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.

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A Novel Cause of Error in Capnographic Confirmation of Intubation in the Neonatal Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.95.1.140 ◽

1995 ◽

Vol 95 (1) ◽

pp. 140-142

Author(s):

William A. Roberts ◽

William M. Maniscalco

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Endotracheal Intubation ◽

Neonatal Intensive Care ◽

Routine Care ◽

Esophageal Intubation ◽

Neurologic Injury ◽

Clinical Indicators ◽

Clinical Criteria ◽

Cause Of Error

Failure to recognize esophageal intubation can result in hypoxia and may lead to permanent neurologic injury. Clinical criteria commonly used to comfirm endotracheal intubation can fail to identify esophageal misplacement.1-9 The risk of this error has been reduced in the operating room by using capnography, which is both sensitive and specific for correct endotracheal intubation.4,6,7,10-12 Capnography is able to identify errant tube placements more rapidly and specifically than clinical indicators alone.10 We report here a novel cause of error in the capnographic findings at intubation in a neonate. CASE REPORT A 26-week gestational age, 690-g neonate was accidentally extubated during routine care.

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Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Journal of International Medical Research ◽

10.1177/0300060519894771 ◽

2019 ◽

Vol 48 (4) ◽

pp. 030006051989477 ◽

Cited By ~ 1

Author(s):

Weiting Chen ◽

Junbo Chen ◽

Hehao Wang ◽

Yingzi Chen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Real Time ◽

Endotracheal Intubation ◽

Fiberoptic Bronchoscopy ◽

Esophageal Intubation ◽

Predictive Values ◽

Kappa Value ◽

Life Threatening ◽

Sensitivity Specificity

Objective Critically ill patients often require emergency endotracheal intubation and mechanical ventilation. When esophageal intubation is not confirmed early, treatment may be delayed, even for life-threatening conditions. We examined the accuracy of bedside real-time airway ultrasonography in confirming the endotracheal tube (ETT) position during emergency endotracheal intubation in patients in the intensive care unit (ICU). Methods This single-center prospective observational study included 118 patients who underwent urgent endotracheal intubation in the ICU of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine. Tracheal ultrasonography was used to confirm the ETT position during endotracheal intubation, after which fiberoptic bronchoscopy was performed. The accuracy of bedside real-time tracheal ultrasonography in determining the ETT position was examined. Results Twelve (10.2%) patients underwent endotracheal intubation. The kappa value was 0.844, indicating perfect consistency between tracheal ultrasonography and fiberoptic bronchoscopy in identifying esophageal intubation. The sensitivity, specificity, and positive and negative predictive values of tracheal ultrasonography in determining the ETT position were 75.0%, 100%, 100%, and 97.2%, respectively. Conclusions Bedside real-time tracheal ultrasonography accurately assesses the ETT position in the ICU and can identify the ETT position during intubation. These findings have important clinical applications and are of great significance for treatment of ICU patients.

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Comparison of VividTrac®, King Vision® and Macintosh laryngoscopy for normal and difficult airways during simulated cardiopulmonary resuscitation among novices

10.21203/rs.3.rs-286601/v1 ◽

2021 ◽

Author(s):

Dóra Keresztes ◽

Ákos Mérei ◽

Martin Rozanovic ◽

Edina Nagy ◽

Zoltán Kovács-Ábrahám ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Difficult Airway ◽

Endotracheal Intubation ◽

User Satisfaction ◽

Macintosh Laryngoscope ◽

Dental Trauma ◽

Esophageal Intubation ◽

Success Rates ◽

Normal Airway ◽

Novice Users

Abstract Background: Successful early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation. However, endotracheal intubation should not compromise cardiopulmonary resuscitation effectiveness and thus requires experience. The use of videolaryngoscopes might decrease the number of attempts as well as the time needed for intubation, especially among novice users. We sought to compare videolaryngoscopes with direct laryngoscopy in simulated cardiopulmonary resuscitation scenarios in mannequins by novices.Methods: Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the King Vision®, the Macintosh laryngoscope and the VividTrac®, on acardiopulmonary resuscitation trainer (Ambu Man Advanced®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction.Results: In the normal airway scenario, significantly shorter intubation times (P < 0.05) were measured by King Vision®than by Macintosh laryngoscope. However, VividTrac® was proven to be similar (P > 0.05) to Macintosh laryngoscope in this regard in the normal airway scenario. In the difficult airway scenarios, we found VividTrac® superior (P < 0.05) to King Vision® and Macintosh laryngoscope regarding laryngoscopy times, but there were no significant differences between devices in intubation times. In both normal and difficult airway cardiopulmonary resuscitation scenarios, we noted no difference (P > 0.05) in first attempt success rates, the best view of the glottis and dental trauma, but esophageal intubation and the use of bougie were more frequent (P < 0.05) withMacintosh laryngoscopethan with videolaryngoscopes. The shortest tube insertion times were related to King Vision® in both scenarios.Conclusion: Based upon our results, King Vision®was superior to Macintosh laryngoscoperegarding intubation time in the normal airway cardiopulmonary resuscitation scenario for novice users. We noted significantly less esophageal intubationwhen using videolaryngoscopes compared to Macintosh laryngoscope in both scenarios; thus,videolaryngoscopes might be recommended for novice users for both cardiopulmonary resuscitation scenarios.

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