Diagnostic Accuracy of Core Stethoscope Auscultation vs. Point of Care Ultrasound in Placement of Endotracheal Tube

NCT ID: NCT04797520

Last Updated: 2025-05-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-30

Study Completion Date

2026-11-30

Brief Summary

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Misplacement of endotracheal tube (ETT) can have devastating complications for patients, some of which include respiratory failure, atelectasis, and pneumothorax.

There are a number of ways to verify the correct placement of ETT, with the stethoscope auscultation being commonly used despite its low accuracy (60-65%) in distinguishing tracheal from bronchial intubation (4-6). The gold standard techniques include Chest X Ray or fiberoptic bronchoscope (7-8), with a recent study showing point-of-care ultrasound. However, these techniques are expensive, time-consuming, often not readily available and require substantial training before users can reliably utilize them. Given intubation is often performed in urgent clinical settings, a technique that can reliably yet efficiently localize ETT would be beneficial.

Tele-auscultation system via Core stethoscope (Eko, Berkeley, CA) has been shown to be effective in identifying pathologic heart murmur (10) yet its potential use in guiding the correct placement of ETT has not been explored. We set out to study the suitability of Core stethoscope in detecting the correct placement of ETT.

Detailed Description

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Conditions

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Intubation Complication

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Treatment

All participants will have placement of ETT confirmed using both Core stethoscope and point-of-care ultrasound

Group Type OTHER

Eko CORE Stethoscope

Intervention Type DEVICE

Eko CORE stethoscope will be used as a visual and auditory means of confirming placement of ETT

Point of care ultrasound

Intervention Type DEVICE

Point of care ultrasound will be used as a means of confirming placement of ETT. This is the "gold standard" used in standard of care

Interventions

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Eko CORE Stethoscope

Eko CORE stethoscope will be used as a visual and auditory means of confirming placement of ETT

Intervention Type DEVICE

Point of care ultrasound

Point of care ultrasound will be used as a means of confirming placement of ETT. This is the "gold standard" used in standard of care

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Any patients under the age of 18
* Surgery requiring an ETT
* Consent/parental consent to

Exclusion Criteria

* Possible difficult airway
* Significant lung pathology
* with any major cardiac anomaly
Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Chi-Ho Ban Tsui

Professor of Anesthesiology, Perioperative and Pain Medicine, Stanford University

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ban Tsui, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Lucille Packard Children's Hospital

Palo Alto, California, United States

Site Status

Countries

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United States

Central Contacts

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Ban Tsui, MD

Role: CONTACT

650-200-9107

Chynna Villanueva, BS, RN

Role: CONTACT

6504986346

References

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Kollef MH, Legare EJ, Damiano M. Endotracheal tube misplacement: incidence, risk factors, and impact of a quality improvement program. South Med J. 1994 Feb;87(2):248-54. doi: 10.1097/00007611-199402000-00020.

Reference Type BACKGROUND
PMID: 8115893 (View on PubMed)

Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Ann Emerg Med. 2012 Sep;60(3):251-9. doi: 10.1016/j.annemergmed.2012.02.013. Epub 2012 Mar 15.

Reference Type BACKGROUND
PMID: 22424653 (View on PubMed)

Jemmett ME, Kendal KM, Fourre MW, Burton JH. Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency medical services setting. Acad Emerg Med. 2003 Sep;10(9):961-5. doi: 10.1111/j.1553-2712.2003.tb00652.x.

Reference Type BACKGROUND
PMID: 12957980 (View on PubMed)

Bissinger U, Lenz G, Kuhn W. Unrecognized endobronchial intubation of emergency patients. Ann Emerg Med. 1989 Aug;18(8):853-5. doi: 10.1016/s0196-0644(89)80211-2.

Reference Type BACKGROUND
PMID: 2757282 (View on PubMed)

Geisser W, Maybauer DM, Wolff H, Pfenninger E, Maybauer MO. Radiological validation of tracheal tube insertion depth in out-of-hospital and in-hospital emergency patients. Anaesthesia. 2009 Sep;64(9):973-7. doi: 10.1111/j.1365-2044.2009.06007.x.

Reference Type BACKGROUND
PMID: 19686482 (View on PubMed)

Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest. 1989 Nov;96(5):1043-5. doi: 10.1378/chest.96.5.1043.

Reference Type BACKGROUND
PMID: 2509149 (View on PubMed)

Sivit CJ, Taylor GA, Hauser GJ, Pollack MM, Bulas DI, Guion CJ, Fearon T. Efficacy of chest radiography in pediatric intensive care. AJR Am J Roentgenol. 1989 Mar;152(3):575-7. doi: 10.2214/ajr.152.3.575.

Reference Type BACKGROUND
PMID: 2783812 (View on PubMed)

Dietrich KA, Strauss RH, Cabalka AK, Zimmerman JJ, Scanlan KA. Use of flexible fiberoptic endoscopy for determination of endotracheal tube position in the pediatric patient. Crit Care Med. 1988 Sep;16(9):884-7. doi: 10.1097/00003246-198809000-00013.

Reference Type BACKGROUND
PMID: 3402233 (View on PubMed)

Ramsingh D, Frank E, Haughton R, Schilling J, Gimenez KM, Banh E, Rinehart J, Cannesson M. Auscultation versus Point-of-care Ultrasound to Determine Endotracheal versus Bronchial Intubation: A Diagnostic Accuracy Study. Anesthesiology. 2016 May;124(5):1012-20. doi: 10.1097/ALN.0000000000001073.

Reference Type BACKGROUND
PMID: 26950708 (View on PubMed)

Behere S, Baffa JM, Penfil S, Slamon N. Real-World Evaluation of the Eko Electronic Teleauscultation System. Pediatr Cardiol. 2019 Jan;40(1):154-160. doi: 10.1007/s00246-018-1972-y. Epub 2018 Aug 31.

Reference Type BACKGROUND
PMID: 30171267 (View on PubMed)

Other Identifiers

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60429

Identifier Type: -

Identifier Source: org_study_id

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