Ultrasound confirmation of nasogastric tube placement in the pre-hospital setting: So why is this of any interest?

In this issue, Chenaitia et al. describe a new point-of-care ultraound (POCUS) application brought into the pre-hospital arena hat has potential for improving patient outcome and impacting are on arrival at the receiving facility.1 High positive predicive value of focused ultrasound assessment of nasogastric (NG) ube tip positioning in the stomach was accomplished by physiians on ambulances who responded to critically ill patients, all f whom required intubation at the scene. Emergency intubations re frequently associated with significant stomach distention from bagging’ the patient to maintain oxygenation prior to tracheal ntubation.2 Use of adjunct airways, such as the laryngeal mask irway, before tracheal intubation is even more likely to result in a istended stomach.3 Despite the non-randomized, focused nature f this research and lack of any outcome data, the study merits dditional comment. Why should anyone care that ultrasound can be used to confirm asogastric tube position in the pre-hospital setting? To colleagues ho see patients only several days after hospital admission, it may ave little relevance. For those who are on the front lines in emerency departments (EDs), intensive care units (ICUs), and operating uites this is an important topic. There is no doubt that intubated atients arriving in an ED can benefit greatly from an accurately laced NG tube and evacuation of the stomach. A stomach that is ull of partially digested food and fluid presents a constant risk of spiration, even in the presence of a correctly placed tracheal tube.4 he air filled, distended stomach decreases chest compression fficacy in patients undergoing CPR.5 Additionally, oxygenation, oronary blood flow and venous return are impaired, which can ip the balance in an unstable patient.6 The growing obesity epiemic in westernized countries means that clinicians are frequently aced with 150 kg patients with round torso shapes that make the elivery of effective ventilation and chest compressions almost mpossible. The presence of a distended stomach makes the chalenge even greater, with some patients being effectively resistant to PR efforts. Evacuation of the stomach can have a significant effect n patient resuscitation, especially in such challenging patients.7