• Ankit Kumar Sahu, Sanjeev Bhoi, Praveen Aggarwal, Roshan Mathew, Jamshed Nayer, Amrithanand V T, Prakash Ranjan Mishra, and Tej Prakash Sinha.
• Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
• J Emerg Med. 2020 Aug 1; 59 (2): 254-264.

BackgroundThe integration of point-of-care ultrasound in endotracheal tube placement confirmation has been focus of many recent studies.ObjectivesWe sought to determine the diagnostic accuracy of ultrasonography in confirmation of endotracheal intubation compared with standard confirmatory methods.MethodsWe completed an extensive search of PubMed, EMBASE, Cochrane Central, Web of Science, and bibliographies of the selected articles from inception to October 2019. The search was limited to prospective studies conducted in human adults that compared the accuracy of ultrasonography in confirming the endotracheal tube position with a reference standard. The methodologic quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model summarized diagnostic accuracy statistics. Subgroup analyses by ultrasonographic signs, study location, the operator's specialty, types of transducer, the technique of ultrasound confirmation, and clinical setting (cardiac arrest vs. non-cardiac arrest) were performed.ResultsThirty studies involving 2534 patients were selected for this meta-analysis. The estimated pooled sensitivity and specificity for ultrasonography were 0.982 (95% confidence interval [CI] 0.971-0.988) and 0.957 (95% CI 0.901-0.982), respectively. Subgroup analyses did not reveal significant difference by ultrasonographic sign used, location, the sonographer's specialty, transducer type, or ultrasound technique used. Ultrasound was also found to be a useful adjunct in confirming endotracheal tube position in the subgroup of patients with cardiac arrest, with sensitivity of 0.99 (95% CI 0.98-1.00) and specificity of 0.84 (95% CI 0.67-1.00), respectively.ConclusionsUltrasonography is a valuable and reliable adjunct for endotracheal tube confirmation, including during cardiac arrest resuscitation.Copyright © 2020 Elsevier Inc. All rights reserved.

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