Study Overview
This was an observational diagnostic accuracy study that took place at
the Aga Khan University Hospital (AKUH) in Karachi Pakistan, in
collaboration with researchers at the Hospital for Sick Children in
Toronto, Canada. AKUH is an academic teaching hospital with over 5000
deliveries per year and a level III NICU. Phase 1 of this study was
completed in 2018 where a POCUS expert trained 60 health care providers
on differentiating esophageal versus tracheal intubations using a novel
ultrasound simulator.25 This included an objective
structured assessment of technical skills (OSATS), ten rounds of
simulator-based testing, and practice on stable ventilated neonates in
the NICU. In phase 2, reported here, these providers used POCUS for
tracheal versus esophageal placement confirmation of ETTs in both the
NICU and the labour room/operating room (LR/OR) for newborns requiring
intubation. This was concurrent with standard-of-care methods including
auscultation, colorimetric capnography, and CXR. Phase 2 of this study
took place from July 2018 to June 2019.