Abstract
We sought to characterize the Sonomatic Confirmation of Tracheal Intubation (SCOTI)
device’s ability to confirm endotracheal tube location during real-time intubation
in emergency and elective settings. Data were prospectively collected during a multicenter
convenience-sample observational trial of emergency and elective intubation cases.
In addition to tracheal and inadvertent esophageal intubations in emergency patients,
intentional esophageal intubations were also performed to improve specificity calculations
in consenting elective surgical patients. Data analysis included descriptive statistics
as well as calculations of sensitivity, specificity, and 95% confidence intervals
(CI). Data were obtained from 220 tracheal and 103 esophageal intubations, 137 (42%)
performed in emergency patients. Fifteen tracheal intubations were incorrectly identified
by SCOTI as esophageal and two esophageal intubations incorrectly as tracheal. Sensitivity
and specificity were thus 93% (CI 90–97%) and 98% (CI 94–99%), respectively. The two
false-positive cases were attributed to gaseous distension of the stomach and esophagus
from prolonged bag-valve-mask ventilation. In addition to use in postprocedure tube
placement confirmation, SCOTI aided the intubation procedure itself in 45 difficult
emergency attempts (33%), 26 of which necessitated blind tube passage. We conclude
that the SCOTI device has high sensitivity and specificity for tube placement confirmation
during tracheal intubation attempts in both emergency and elective settings. It also
facilitates tube placement itself during difficult intubations. As such it may be
considered an adjunctive device to minimize the potentially fatal complication of
esophageal intubation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- SCOTI—a new device for identification of tracheal intubation.Anaesthesia. 1995; 50: 1062-1064
Martin B, Wheatley E. Clinical evaluation of the SCOTI device [abstract]. Eleventh World Congress of Anaesthesiologists 1996; F285.
- SCOTI vs. Wee. An assessment of two oesophageal intubation detection devices.Anaesthesia. 1997; 52: 242-243
- An evaluation of the SCOTI device.Anaesthesia. 1997; 52: 453-456
- Evaluation of the SCOTI device for confirming blind nasal intubation.Anaesthesia. 1999; 54: 347-349
- Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation.Ann Emerg Med. 1996; 27: 595-599
- Clinical utility of a colorimetric end-tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation.J Clin Monit. 1991; 7: 289-293
- Validity of a disposable end-tidal CO2 detector in verifying endotracheal tube placement in infants and children.Ann Emerg Med. 1992; 21: 142-145
- Colorimetric end-tidal CO2 detector for verification of endotracheal tube placement in out-of-hospital cardiac arrest.Acad Emerg Med. 1995; 2: 499-502
- Safety evaluation and confidence intervals when number of observed events is small or zero.Ann Emerg Med. 1997; 30: 301-306
Salem MR, Wafai Y. Practical confirmation of endotracheal intubation in the trauma patient. Anesthesiology News 1997;Jan:4–32.
- Complications of emergency intubation with and without paralysis.Am J Emerg Med. 1999; 17: 141-143
- Death and other complications of emergency airway management in critically ill adults.Anesthesiology. 1995; 82: 367-376
- The esophageal detector device. Does it work?.Anesthesiology. 1993; 79: 244-247
- Evaluation of a prototype esophageal detection device.Acad Emerg Med. 1995; 2: 503-507
- The syringe aspiration technique to verify endotracheal tube position.Am J Emerg Med. 1994; 12: 413-416
- Airway geometry by analysis of acoustic pulse response measurements.J Appl Physiol. 1977; 43: 523-536
Article info
Publication history
Accepted:
October 16,
2000
Received in revised form:
August 7,
2000
Received:
April 10,
2000
Identification
Copyright
© 2001 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
