Point-of-care ultrasound for confirming endotracheal tube placement in prehospital and critical care transport: a scoping review.
Internal and Emergency Medicine · 2026-10-26 · Scoping review
Abstract
Point-of-care ultrasound (POCUS) has demonstrated high pooled diagnostic accuracy for endotracheal tube (ETT) placement confirmation in adult Emergency Departments and Intensive Care Units,, but its translation to pre-hospital and Critical Care Transport (CCT) environments is unclear. We mapped the published evidence on POCUS-based ETT placement confirmation in transport, organized around six axes: clinical indication, transport modality, operator training, impact on management, technical barriers, and patient-oriented outcomes. Scoping review per the Joanna Briggs Institute 2020 framework, reported per PRISMA-ScR. Nine sources searched January 1st, 2015-May 12th, 2026: PubMed/MEDLINE, Embase, CINAHL, Cochrane Library, Europe PMC, Consensus.app, Google Scholar, ClinicalTrials.gov, and forward-citation tracking. Dual independent screening and charting were performed in Covidence with built-in conflict adjudication. From 2447 unique records, 51 met final inclusion. One primary study evaluated diagnostic performance in adult patients in an out-of-hospital setting. The remaining 50 records comprised contextual primary studies and secondary evidence, including cadaver and simulation studies, training evaluations, feasibility implementations, and reviews. Distribution by modality was skewed toward ground emergency medical services (EMS); rotor-wing helicopter EMS (HEMS) evidence was predominantly training-based; fixed-wing evidence was essentially absent. Operator profiles in transport-relevant studies were predominantly paramedic, flight medic, or flight nurse, mismatched against the physician-dominant pooled in-hospital meta-analytic estimates. No included study measured patient-oriented outcomes. Evidence supporting POCUS-based ETT confirmation in pre-hospital and critical care transport remains limited. Most studies addressed training, simulation, feasibility, or implementation rather than diagnostic performance in transported patients, and none demonstrated an effect on patient-oriented outcomes. Transport-specific prospective studies are needed before hospital-derived diagnostic-accuracy estimates can be generalized to transport practice.
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Tags
Helicopter & air ambulance · Interfacility & critical care transport · Point-of-care ultrasound
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