Integration of Point of Care Ultrasound during Rapid Sequence Intubation in Trauma Resuscitation

Abstract

Introduction: Rapid Sequence Intubation (RSI) is the definitive modality of airway management when resuscitating trauma patients in the Emergency Department (ED). This study was done to evaluate the utility of POCUS in RSI and its efficacy in confirming tube placement as compared to conventional methods. Aims & Objectives: Primary Objectives - Time taken for airway evaluation and identifying potentially fatal conditions using POCUS guided Intubation Algorithm (PA) during RSI. Proper placement of the endotracheal tube and confirmation of the same was also assessed and compared with the conventional technique. Methodology: A prospective, randomized single-centred study was conducted in 100 trauma patients requiring emergent airway management, presenting to the ED. The time taken and efficacy of confirmation of tube placement is recorded and compared in two arms. Results: In our study we found the mean procedure time for ETT placement was less in the PA arm compared to the CE arm (45 vs 91.36 seconds, p<0.0001). Oesophageal intubations were detected in the PA arm in 22 seconds vs 114 seconds in CE arm with a p< 0.0001 and the time taken for effective reintubation was 26.67 vs 55 seconds in the PA and CE arm with a p value < 0.007 respectively. Conclusion: POCUS detected oesophageal intubations and confirmed proper tube position in less time when compared to standard techniques such as five-point auscultation and capnography. The results of this study have proved that POCUS is a useful adjunct to the Emergency physician to improve quality of care in trauma patients. Keywords: Point of care ultrasound, Rapid sequence intubation, Trauma, Emergency department, Emergency physician, Endotracheal tube, End tidal carbon dioxide, Ultrasound, Clinical examination