A Novel Training Simulator for Portable Ultrasound Identification of Incorrect Newborn Endotracheal Tube Placement

Placing an endotracheal tube (ETT) is an essential part of respiratory support for newborns who are unable to breathe. Unfortunately, placing the ETT into the esophagus (swallowing tube) instead of the airway occurs commonly, and current methods to detect this error are notoriously unreliable and slow, depriving the brains of these fragile newborns of oxygen long enough to cause permanent damage. Portable ultrasound of the neck has recently emerged as a powerful improvement for detecting esophageal ETTs. It is more accurate and faster than current detection methods, and is also easy to learn and perform, especially on children. The technology, however, is not being used in delivery rooms where it has the potential to be very effective in patients with very small and unique airway anatomy. To assist neonatal providers in detecting esophageal ETTs in the delivery room, we have developed a novel ultrasound simulator. The simulator can be prepared with simple materials anywhere in the world making it cost-effective and easily scalable. Building on a partnership between Aga Khan Hospital, Pakistan, and Sick Kids Hospital, our study tests whether providers at all levels, with no experience in portable ultrasound for ETT placement, can become proficient after 1 hour of training with the simulator. This Bold Idea represents the first step in translating the established benefits of portable ultrasound for ETT confirmation to the sickest newborns undergoing resuscitation.