The diagnostic accuracy of point‐of‐care ultrasound parameters for airway assessment in patients undergoing intubation in emergency department—an observational study

The diagnostic accuracy of point‐of‐care ultrasound parameters for airway assessment in patients undergoing intubation in emergency department—an observational study

Difficult intubation, Airway ultrasound, Emergency department

Background Endotracheal intubation is an essential resuscitative procedure in the emergency setting. Airway assess-
ment parameters such as the Mallampati classification are difficult to perform in an emergency setting. As point-
of-care ultrasound (POCUS) assessment of airway parameters does not require patients to perform any mandatory

action, ultrasound may become the potential first-line noninvasive airway assessment tool in the emergency depart-
ment (ED). The use of POCUS in the ED has not been sufficiently studied. Using POCUS in airway assessment for pre-
dicting difficult intubation may be the next step in successful airway management.

Methodology The study was an observational study conducted at the ED of the All India Institute of Medical
Sciences (Rishikesh). The treating emergency physician recorded the patient history and systemic examination

along with an indication for intubation. The POCUS assessment of airway parameters pre-epiglottis to epiglot-
tic vocal cord ratio (Pre-E/E-VC), tongue thickness, hyomental distance, and distance from skin to the hyoid bone

was performed by the study investigator. During laryngoscopy, Cormack-Lehane (CL) grading was assessed. The data
was entered and analyzed.
Results Seventy patients who required intubation in the ED were enrolled in the study. Among the study population,
48.6%, 28.6%, 14.3%, 1.4%, and 7.1% were classified with the following CL grading: 1, 2a, 2b, 3a, and 3b, respectively.
At a cutoff of ≥ 1.86, Pre-E/E-VC predicts difficult laryngoscopy (AUC 0.835) with a sensitivity of 83% and a specificity
of 94%. At a cutoff of ≥ 5.98 cm, tongue thickness predicts difficult laryngoscopy (AUC 0.78) with a sensitivity of 83%

and a specificity of 88%. At a cutoff of hyomental distance ≤ 6 cm, it predicts difficult laryngoscopy with a sensitiv-
ity of 83% and a specificity of 88%. All parameters can act as a promising tool for predicting difficult laryngoscopy,

with the single best parameter being Pre-E/E-VC.

Aadya Pillai1

, Poonam Arora2*, Ankita Kabi3

, Udit Chauhan4

, Reshma Asokan5
, P. Akhil6
, Takshak Shankar2
,

D. J. Lalneiruol1

, Himanshi Baid7 and Hannah Chawang1

https://doi.org/10.1186/s12245-024-00585-6

2024

Peri Irawan

pdf

english

text