Kaminski Ann, Dike Nkechi O, Bachista Kerry, Boniface Michael, Dove Conrad, Simon Leslie V
Emergency Medicine, Mayo Clinic, Jacksonville, USA.
Emergency Medicine/Clinical Anatomy, University of Cape Coast, Cape Coast, GHA.
Cureus. 2020 Jun 18;12(6):e8686. doi: 10.7759/cureus.8686.
Objectives Airway ultrasound is now possible in the prehospital setting due to advances in ultrasound equipment portability. We questioned how well prehospital providers without prior experience could determine both esophageal and tracheal placement of an endotracheal tube in cadavers after a brief training course in ultrasound. Methods This educational prospective study at the Simulation Center in Mayo Clinic Jacksonville Florida enrolled 50 prehospital providers. Demographic and practice background information was obtained through surveys. Each participant performed a baseline ultrasound to determine endotracheal tube placement in a cadaver that was randomly assigned to an esophageal or tracheal intubation. Participants then repeated the randomized testing after a 15-minute tutorial. Before and after overall accuracy as well as proportions of correct identification of esophageal and tracheal intubations were determined and compared using standard binomial proportion and McNemar's tests. Results None of the participants had prior experience of performing airway ultrasound. Baseline group scores were 60% (CI 45%-74%) for overall accuracy (n=50), 55% (CI 32%-76%) for correct identification of an esophageal intubation, and 64% (CI 44%-81%) for correct tracheal detection. Baseline scores were not significantly different from standard binomial distributions. Post-test scores were 82% (CI 69%-91%) for overall accuracy, 96% (CI 80%-100%) for esophageal intubation detection, and 66.7% (CI 45%-84%) for tracheal intubation detection, with corresponding binomial p-values of <0.001, <0.001, and 0.15. P-values for McNemar's paired test for combined overall accuracy, correct esophageal detection, and correct tracheal detection were 0.04, 0.02, and 0.62, respectively. Conclusions Prehospital participants without prior ultrasound experience demonstrated significant gains in airway ultrasound proficiency after a limited introductory course. Post-training score increases were largely due to a notable increase in correct esophageal intubation detection rates. Learners did not make significant progress in correctly identifying a tracheal intubation. Airway ultrasound educational design may benefit from added emphasis on the potentially more difficult to recognize tracheal intubation view.
目的 由于超声设备便携性的提高，院前气道超声检查现已成为可能。我们想了解，在接受简短的超声培训课程后，没有经验的院前急救人员在尸体上确定气管内导管的食管和气管位置的能力如何。方法 这项前瞻性教育研究在佛罗里达州杰克逊维尔市梅奥诊所的模拟中心进行，招募了50名院前急救人员。通过调查获取人口统计学和实践背景信息。每位参与者进行一次基线超声检查，以确定随机分配为食管插管或气管插管的尸体上气管内导管的位置。然后，参与者在接受15分钟的指导后重复进行随机测试。使用标准二项式比例和McNemar检验确定并比较总体准确性以及食管和气管插管正确识别比例的前后情况。结果 所有参与者此前均无气道超声检查经验。总体准确性的基线组得分是60%（可信区间45%-74%）（n = 50），食管插管正确识别率为55%（可信区间32%-76%），气管插管正确检测率为64%（可信区间44%-81%）。基线得分与标准二项分布无显著差异。测试后总体准确性得分是82%（可信区间69%-91%），食管插管检测率为96%（可信区间80%-100%），气管插管检测率为66.7%（可信区间45%-84%），相应的二项式p值分别为<0.001、<0.001和0.15。McNemar配对检验中总体准确性、食管正确检测和气管正确检测的p值分别为0.04、0.02和0.62。结论 没有超声经验的院前急救人员在接受有限的入门课程后，气道超声检查熟练程度有显著提高。培训后得分的提高主要归因于食管插管正确检测率的显著提高。学习者在正确识别气管插管方面没有取得显著进展。气道超声教育设计可能受益于对可能更难识别的气管插管视图给予更多强调。
