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Eun S, Yoon H, Kang SY, Jo IJ, Heo S, Chang H, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Baek SY. Real-Time Tracheal Ultrasound vs. Capnography for Intubation Confirmation during CPR Wearing a Powered Air-Purifying Respirator in COVID-19 Era. Diagnostics (Basel) 2024; 14:225. [PMID: 38275472 PMCID: PMC10813934 DOI: 10.3390/diagnostics14020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
This study aimed to compare the accuracy of real-time trans-tracheal ultrasound (TTUS) with capnography to confirm intubation in cardiopulmonary resuscitation (CPR) while wearing a powered air-purifying respirator (PAPR). This setting reflects increased caution due to contagious diseases. This single-center, prospective, comparative study enrolled patients requiring CPR while wearing a PAPR who visited the emergency department of a tertiary medical center from December 2020 to August 2022. A physician performed the TTUS in real time and recorded the tube placement assessment. Another healthcare provider attached waveform capnography to the tube and recorded end-tidal carbon dioxide (EtCO2) after five ventilations. The accuracy and agreement of both methods compared with direct laryngoscopic visualization of tube placement, and the time taken by both methods was evaluated. Thirty-three patients with cardiac arrest were analyzed. TTUS confirmed tube placement with 100% accuracy, sensitivity, and specificity, whereas capnography demonstrated 97% accuracy, 96.8% sensitivity, and 100% specificity. The Kappa values for TTUS and capnography compared to direct visualization were 1.0 and 0.7843, respectively. EtCO2 was measured in 45 (37-59) seconds (median (interquartile range)), whereas TTUS required only 12 (8-23) seconds, indicating that TTUS was significantly faster (p < 0.001). No significant correlation was found between the physician's TTUS proficiency and image acquisition time. This study demonstrated that TTUS is more accurate and faster than EtCO2 measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.
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Affiliation(s)
- Seungwan Eun
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Soo Yeon Kang
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si 14353, Republic of Korea;
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea (I.J.J.); (S.H.); (H.C.); (G.L.); (J.E.P.); (T.K.)
| | - Sun-Young Baek
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
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