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.