Gastric Ultrasound for Airway Management in Emergency Patients

Indonesia University43 enrolled

Overview

This prospective observational cohort study evaluates the association between gastric residual content and volume, assessed by point-of-care gastric ultrasound (PoCUS), and the choice of airway management technique (Rapid Sequence Intubation vs. non Rapid Sequence Intubation) in adult emergency surgical patients at Rumah Sakit Cipto Mangunkusumo (RSCM). Aspiration risk in emergency patients is a critical concern, and this study examines whether objective ultrasonographic findings change clinical decision-making compared to traditional clinical assessment alone.

Emergency patients frequently have delayed gastric emptying, increasing aspiration risk during airway management. Gastric PoCUS allows non-invasive, bedside assessment of gastric content (empty, liquid, solid, or mixed) and volume. This study quantifies gastric antrum cross-sectional area (CSA) using the Perlas formula (GV = 27.0 + 14.6 × CSA - 1.28 × age) and reports whether USG findings influenced the anesthesiologist's plan (RSI or non-RSI).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Pulmonary Aspiration of Gastric Contents Emergency Surgery Gastric Residual Volume Airway Management

Interventions

Preoperative Gastric Point-of-Care Ultrasound (PoCUS)DEVICE

Gastric antrum ultrasound performed using a low-frequency transducer (2-5 MHz; SonoSite M-Turbo or Lumify Philips) in the supine position before anesthetic induction. The antrum cross-sectional area (CSA) was measured during the relaxation phase between two peristaltic contractions, calculating cranio-caudal (CC) and antero-posterior (AP) diameters. Gastric residual volume (GRV) was calculated using the Perlas formula: GV = 27.0 + 14.6 × CSA - 1.28 × age (years). Gastric content was classified as empty, liquid, solid, or mixed. Aspiration risk was categorized as high (GRV ≥1.5 ml/kg or solid content) or low (GRV \<1.5 ml/kg or empty).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Emergency patients requiring airway management in the Emergency Operating Room * Age \>18 years Exclusion Criteria: * Pregnancy * Morbid obesity (BMI \>40 kg/m²) * History of prior gastric or esophageal surgery * Duodenal tube in situ * Maxillofacial trauma or anticipated difficult airway * Inability to adequately visualize the gastric antrum on ultrasound

Locations (1)

RSUPN Cipto Mangunkusumo

Jakarta, Jakarta Special Capital Region, Indonesia

Outcomes

Primary Outcomes

Association between aspiration risk based on gastric ultrasound findings and airway management technique selection

Proportion of patients in whom airway management technique (Rapid Sequence Intubation vs. non Rapid Sequence Intubation) was associated with aspiration risk category (high vs. low) determined by preoperative gastric Point-of-Care Ultrasound (PoCUS) findings. Aspiration risk classified as high if Gastric Residual Volume (GRV) ≥1.5 ml/kg or solid gastric content; low if GRV \<1.5 ml/kg or empty stomach. Analyzed using chi-square test.

Time frame: At time of pre-induction assessment (single time point, intraoperative)

Secondary Outcomes

Change in Airway Management Plan After Gastric USG

Comparison of airway management plan (RSI vs. non-RSI) before and after disclosure of gastric USG findings to the treating anesthesiologist. Analyzed using McNemar's paired categorical test.

Time frame: Before and immediately after gastric USG, prior to anesthetic induction

Gastric Residual Volume

Gastric residual volume calculated using the Perlas formula: GV = 27.0 + 14.6 × CSA - 1.28 × age (years), based on antrum cross-sectional area (CSA) measured from cranio-caudal (CC) and antero-posterior (AP) diameters. Reported as mean ± SD or median (range).