Real-Time Tracheal Ultrasound vs. Capnography for Intubation Confirmation during CPR Wearing a Powered Air-Purifying Respirator in COVID-19 Era

• Published in: Diagnostics (Basel) Vol. 14; no. 2; p. 225
• Main Authors: Eun, Seungwan, Yoon, Hee, Kang, Soo Yeon, Jo, Ik Joon, Heo, Sejin, Chang, Hansol, Lee, Guntak, Park, Jong Eun, Kim, Taerim, Lee, Se Uk, Hwang, Sung Yeon, Baek, Sun-Young
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.01.2024
• Subjects: Accuracy; Airway management; Auscultation; Cardiac arrest; Cardiac patients; Cardiopulmonary resuscitation; COVID-19; CPR; emergency department: point-of-care ultrasound; Emergency medical care; endotracheal intubation; Esophagus; Gas masks; Infectious diseases; Intubation; Lifesaving; Lungs; Pandemics; Patients; personal protective equipment; Ultrasonic imaging; ultrasound; Visualization; South Korea; United States > US; cardiopulmonary resuscitation; personal protective equipment; endotracheal intubation; CPR; emergency department: point-of-care ultrasound; ultrasound
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14020225

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 (EtCO ) 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. EtCO was measured in 45 (37-59) seconds (median (interquartile range)), whereas TTUS required only 12 (8-23) seconds, indicating that TTUS was significantly faster ( < 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 EtCO measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.