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Not yet recruitingNCT04797520Updated May 4, 2025

Diagnostic Accuracy of Core Stethoscope Auscultation vs. Point of Care Ultrasound in Placement of Endotracheal Tube

An interventional study of Eko CORE Stethoscope and Point of care ultrasound in Intubation Complication, sponsored by Stanford University. Not yet recruiting at 1 site in United States. Open to participants aged Up to 18 Years. Per ClinicalTrials.gov, last updated 2025-05-04.

Sponsored by Stanford University · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
100
Allocation
Not applicable
Ages
Up to 18 Years
Sex
All
01

Study summary

Misplacement of endotracheal tube (ETT) can have devastating complications for patients, some of which include respiratory failure, atelectasis, and pneumothorax.

There are a number of ways to verify the correct placement of ETT, with the stethoscope auscultation being commonly used despite its low accuracy (60-65%) in distinguishing tracheal from bronchial intubation (4-6). The gold standard techniques include Chest X Ray or fiberoptic bronchoscope (7-8), with a recent study showing point-of-care ultrasound. However, these techniques are expensive, time-consuming, often not readily available and require substantial training before users can reliably utilize them. Given intubation is often performed in urgent clinical settings, a technique that can reliably yet efficiently localize ETT would be beneficial.

Tele-auscultation system via Core stethoscope (Eko, Berkeley, CA) has been shown to be effective in identifying pathologic heart murmur (10) yet its potential use in guiding the correct placement of ETT has not been explored. We set out to study the suitability of Core stethoscope in detecting the correct placement of ETT.

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Conditions studied

  • Intubation Complication
03

In context

Lead sponsor

Stanford University is the lead sponsor of 2,117 studies on the registry; 425 are open to participants now.

Of its 259 completed or terminated interventional studies of FDA-regulated products, 197 (76%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
Up to 18 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Any patients under the age of 18
  • Surgery requiring an ETT
  • Consent/parental consent to

Exclusion criteria

Exclusion Criteria:

  • Possible difficult airway
  • Significant lung pathology
  • with any major cardiac anomaly
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Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
100 participants (estimated)

Study arms

  • Other
    Treatment

    All participants will have placement of ETT confirmed using both Core stethoscope and point-of-care ultrasound

    Device: Eko CORE Stethoscope · Device: Point of care ultrasound

Interventions

  • DeviceEko CORE Stethoscope

    Eko CORE stethoscope will be used as a visual and auditory means of confirming placement of ETT

  • DevicePoint of care ultrasound

    Point of care ultrasound will be used as a means of confirming placement of ETT. This is the "gold standard" used in standard of care

06

What researchers measure

Primary outcomes

  1. Localization of endotracheal tube placement by the presence/absence of lung pleural linings movement by ultrasound

    Ultrasound placed vertically on the anterior chest of a patient will assess for the presence/absence of the horizontal movement of the two lung pleural linings with respiration.

    Time frame: During assessment with point of care ultrasound (10min)

  2. Localization of endotracheal tube placement by the presence/absence of breath sounds detected by Core-Eko augmented stethoscope

    Presence of breath sounds will be assessed and recorded using Core-Eko augmented stethoscope, in conjunction with the smartphone interface over Bluetooth, by auscultating patient's chest. The technology will display breath sounds as a visual soundwave on the smartphone. As a result, this will be used to determine location of endotracheal tube (for example, if breath sounds absent in the left lung, we would infer that the tube is in the right bronchus).

    Time frame: During assessment with Core-Eko augmented stethoscope auscultation (5min)

07

Study locations

1 site
  • Lucille Packard Children's Hospital
    Palo Alto, California 94304, United States
08

References and documents

Publications

  • Kollef MH, Legare EJ, Damiano M. Endotracheal tube misplacement: incidence, risk factors, and impact of a quality improvement program. South Med J. 1994 Feb;87(2):248-54. doi: 10.1097/00007611-199402000-00020. PubMed 8115893 ↗
  • Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Ann Emerg Med. 2012 Sep;60(3):251-9. doi: 10.1016/j.annemergmed.2012.02.013. Epub 2012 Mar 15. PubMed 22424653 ↗
  • Jemmett ME, Kendal KM, Fourre MW, Burton JH. Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency medical services setting. Acad Emerg Med. 2003 Sep;10(9):961-5. doi: 10.1111/j.1553-2712.2003.tb00652.x. PubMed 12957980 ↗
  • Bissinger U, Lenz G, Kuhn W. Unrecognized endobronchial intubation of emergency patients. Ann Emerg Med. 1989 Aug;18(8):853-5. doi: 10.1016/s0196-0644(89)80211-2. PubMed 2757282 ↗
  • Geisser W, Maybauer DM, Wolff H, Pfenninger E, Maybauer MO. Radiological validation of tracheal tube insertion depth in out-of-hospital and in-hospital emergency patients. Anaesthesia. 2009 Sep;64(9):973-7. doi: 10.1111/j.1365-2044.2009.06007.x. PubMed 19686482 ↗
  • Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest. 1989 Nov;96(5):1043-5. doi: 10.1378/chest.96.5.1043. PubMed 2509149 ↗
  • Sivit CJ, Taylor GA, Hauser GJ, Pollack MM, Bulas DI, Guion CJ, Fearon T. Efficacy of chest radiography in pediatric intensive care. AJR Am J Roentgenol. 1989 Mar;152(3):575-7. doi: 10.2214/ajr.152.3.575. PubMed 2783812 ↗
  • Dietrich KA, Strauss RH, Cabalka AK, Zimmerman JJ, Scanlan KA. Use of flexible fiberoptic endoscopy for determination of endotracheal tube position in the pediatric patient. Crit Care Med. 1988 Sep;16(9):884-7. doi: 10.1097/00003246-198809000-00013. PubMed 3402233 ↗
  • Ramsingh D, Frank E, Haughton R, Schilling J, Gimenez KM, Banh E, Rinehart J, Cannesson M. Auscultation versus Point-of-care Ultrasound to Determine Endotracheal versus Bronchial Intubation: A Diagnostic Accuracy Study. Anesthesiology. 2016 May;124(5):1012-20. doi: 10.1097/ALN.0000000000001073. PubMed 26950708 ↗
  • Behere S, Baffa JM, Penfil S, Slamon N. Real-World Evaluation of the Eko Electronic Teleauscultation System. Pediatr Cardiol. 2019 Jan;40(1):154-160. doi: 10.1007/s00246-018-1972-y. Epub 2018 Aug 31. PubMed 30171267 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on May 4, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT04797520
Lead sponsor
Stanford University
Responsible party
Chi-Ho Ban Tsui (Professor of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford University) — Principal investigator
First posted
Mar 15, 2021
Start date
Nov 2025 (estimated)
Primary completion
Nov 2026 (estimated)
Completion
Nov 2026 (estimated)
Last update
May 4, 2025

Study contacts

Ban Tsui, MD
Contact
bantsui@stanford.edu
650-200-9107
Chynna Villanueva, BS, RN
Contact
chynnav@stanford.edu
6504986346
Ban Tsui, MD
principal investigator · Stanford University

Oversight

FDA-regulated drug
No
FDA-regulated device
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is not yet recruiting, as verified in Apr 2025. You cannot join it, but the record below documents what was studied.

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