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2015 ; 7
(1
): 14
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Defining the learning curve of point-of-care ultrasound for confirming
endotracheal tube placement by emergency physicians
#MMPMID26383011
Chenkin J
; McCartney CJ
; Jelic T
; Romano M
; Heslop C
; Bandiera G
Crit Ultrasound J
2015[Dec]; 7
(1
): 14
PMID26383011
show ga
BACKGROUND: Unrecognized esophageal intubations are associated with significant
patient morbidity and mortality. No single confirmatory device has been shown to
be 100 % accurate at ruling out esophageal intubations in the emergency
department. Recent studies have demonstrated that point-of-care ultrasound
(POCUS) may be a useful adjunct for confirming endotracheal tube placement;
however, the amount of practice required to become proficient at this technique
is unclear. The purpose of this study is to determine the amount of practice
required by emergency physicians to become proficient at interpreting ultrasound
video clips of esophageal and endotracheal intubations. METHODS: Emergency
physicians and emergency medicine residents completed a baseline interpretation
test followed by a 10 min online tutorial. They then interpreted POCUS clips of
esophageal and endotracheal intubations in a randomly selected order. If an
incorrect response was provided, the participant completed another practice
session with feedback. This process continued until they correctly interpreted
ten consecutive ultrasound clips. Descriptive statistics were used to summarize
the data. RESULTS: Of the 87 eligible physicians, 66 (75.9 %) completed the
study. The mean score on the baseline test was 42.9 % (SD 32.7 %). After the
tutorial, 90.9 % (60/66) of the participants achieved proficiency after one
practice attempt and 100 % achieved proficiency after two practice attempts. Six
intubation ultrasound clips were misinterpreted, for a total error rate of 0.9 %
(6/684). Overall, the participants had a sensitivity of 98.3 % (95 % CI
96.3-99.4 %) and specificity of 100 % (95 % CI 98.9-100 %) for detecting correct
tube location. Scans were interpreted within an average of 4 s (SD 2.9 s) of the
intubation. CONCLUSIONS: After a brief online tutorial and only two practice
attempts, emergency physicians were able to quickly and accurately interpret
ultrasound intubation clips of esophageal and endotracheal intubations.