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Airway Confirmation

Date Last Search Run: Aug 01, 2024
Table last updated: May 02, 2021
Data last added: Sep 30, 2020

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)  
3 (weak evidence exists)      


Interventions

EDD
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Correct placement detection Process OR Salem M., Wafai Y., Joseph N., et al. Efficacy of the self-inflating bulb in detecting esophageal intubation. Anesthesiology 1994; 80:42-8. Medline
II Supportive (Green) Sensitivity & specificity Process PH-Paramedic Schaller RJ., Huff JS., Zahn A. Comparison of a colorimetric end-tidal CO2 detector and an esophageal aspiration device for verifying endotracheal tube placement in the prehospital setting: A six-month experience. Prehosp Disaster Med 1997; 12(1):57-63. Medline
II Supportive (Green) Detection of esophageal intubation Process OR Zaleski L., Abello D., Martin G. The esophageal detector device. Anesthesiology 1993; 79:244-247. Medline
II Neutral (Yellow) Sensitivity and Specificity of detecting Esophageal intubation Patient ED-MD Takeda T., Tanigawa K., Tanaka H., Hayashi Y., et al. The assessment of three methods to verify tracheal tube placement in the emergency setting. Resusc 2003; 56(2)153-7. Medline
II Neutral (Yellow) Sensitivity and specificity Patient PH-Paramedic Verbeek R., Bandiera G., Morris B., et al. Bias in a prehospital esophageal detector device trial: Lessons learned. CJEM 2000; 2(3):163-168 (abstract). Medline
III Supportive (Green) Sensitivity and specificity Process PH-Paramedic Bozeman W., Hexter D., Liang H., et al. Esophageal detector device versus detection of end-tidal carbon dioxide level in emergency intubation. Ann Emerg Med 1996; 27:595-9. Medline
III Supportive (Green) Accuracy Process OR Donahue P. The oesophageal detector device. Anaesthesia 1994; 49:863-5. Medline
III Supportive (Green) Time to determine tube placement Process Foutch RG., Magelssen MD., MacMillan JG. The esophageal detector device: A rapid and accurate method for assessing tracheal versus esophageal intubation in a porcine model. Ann Emerg Med 1992; 21:1073-6. Medline
III Supportive (Green) Sensitivity/Specificity for successful intubation Patient Hendey GW., Shubert GS., Shalit M., Hogue B. The esophageal detector bulb in the aeromedical setting. J Emerg Med 2002; 23(1):51-5. Medline
III Supportive (Green) Sensitivity and Specificity Process PH-Paramedic Marley C., Eitel D., Koch M., et al. Prehospital use of a prototype esophageal detection device: A word of caution. Prehospital and Disaster Medicine 1996; 11:78-82. Medline
III Neutral (Yellow) Sensitivity Patient PH-Paramedic Tanigawa K., Takeda T., Goto E., Tanaka K. The efficacy of esophageal detector devices in verifying tracheal tube placement: A randomized cross-over study of out-of-hospital cardiac arrest patients. Anesth Analg 2001; 92(2):375-378. Medline
III Opposes (Red) Sensitivity and specificity Process PH-Paramedic Pelucio M., Halligan L., Dhindsa H. Out-of-hospital experience with the syringe esophageal detector device. Acad Emerg Med 1997; 4:563-8. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline

Oxymetry Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Equipment malfunction Process PH-Paramedic Kober A., Schubert B., Bertalanffy P., Gorove L., Puskas T., Gustorff B., et al. Capnography in non-tracheally intubated emergency patients as an additional tool in pulse oximetry for prehospital monitoring of respiration. Anesth Analg 2004; 98(1):206-10. Medline
III Opposes (Red) Intervention decision-making based on pulse oximetry Process PH-Paramedic Aguilar SA., Davis DP. Latency of pulse oximetry signal with use of digital probes associated with inappropriate extubation during prehospital rapid sequence intubation in head injury patients: Case examples. J Emerg Med 2012; 42(4):424-8. Medline

POCUS
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Confirmation of placement Process ED-MD Gottlieb M., Holladay D., Peksa GD. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med 2018; 72(6):627-36. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline

Qualitative ETCO2 (no circulation)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Intubation success, Oxygen saturation Process PH-Paramedic Davis DP., et al. Predictors of intubation success and therapeutic value of paramedic airway management in a large, urban EMS system. Prehosp Emerg Care 2006; 10:356-62. Medline
II Supportive (Green) Sensitivity & specificity Process PH-Paramedic Schaller RJ., Huff JS., Zahn A. Comparison of a colorimetric end-tidal CO2 detector and an esophageal aspiration device for verifying endotracheal tube placement in the prehospital setting: A six-month experience. Prehosp Disaster Med 1997; 12(1):57-63. Medline
II Neutral (Yellow) Sensitivity Process ED-MD Anton WR., Gordon RW., Jordan TM., Posner KL., Cheney FW. A disposable end-tidal CO2 detector to verify endotracheal intubation. Ann Emerg Med 1991; 20(3):271-5. Medline
II Neutral (Yellow) Effectiveness of intubation confirmation Process ED-MD Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001; 20(3):223-229. Medline
II Neutral (Yellow) Sensitivity and Specificity Process PH-Paramedic MacLeod B., Heller M., Gerard J., et al. Verification of endotracheal tube placement with colorimetic end-tidal CO2 detection. Ann Emerg Med 1991; 20:267-270. Medline
II Neutral (Yellow) Detection end airway confirmation Process PH-Paramedic Nakatani K., Yukioka H., Fujimori M., Maeda C., et al. Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation. Am J Emerg Med 1999; 17(2)203-6. Medline
II Neutral (Yellow) Sensitivity and specificity Process PH-Paramedic Ornato J., Shipley J., Racht E., et al: Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med 1992; 21:518-23. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline

Qualitative ETCO2 (with circulation)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Sensitivity and specificity OR Angelotti T., Weiss EL., Lemmens HJ., Brock-Utne J. Verification of endotracheal tube placement by prehospital providers: Is a portable fiberoptic bronchoscope of value? Air Med J 2006; 25(2):74-8 Medline
II Supportive (Green) Sensitivity Process ED-MD Anton WR., Gordon RW., Jordan TM., Posner KL., Cheney FW. A disposable end-tidal CO2 detector to verify endotracheal intubation. Ann Emerg Med 1991; 20(3):271-5. Medline
II Supportive (Green) Sensitivity and Specificity Process PH-Paramedic MacLeod B., Heller M., Gerard J., et al. Verification of endotracheal tube placement with colorimetic end-tidal CO2 detection. Ann Emerg Med 1991; 20:267-270. Medline
II Supportive (Green) Sensitivity and specificity Process PH-Paramedic Ornato J., Shipley J., Racht E., et al: Multicenter study of a portable, hand-size, colorimetric end-tidal carbon dioxide detection device. Ann Emerg Med 1992; 21:518-23. Medline
II Supportive (Green) Sensitivity & specificity Process PH-Paramedic Schaller RJ., Huff JS., Zahn A. Comparison of a colorimetric end-tidal CO2 detector and an esophageal aspiration device for verifying endotracheal tube placement in the prehospital setting: A six-month experience. Prehosp Disaster Med 1997; 12(1):57-63. Medline
II Neutral (Yellow) Effectiveness of intubation confirmation Process ED-MD Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001; 20(3):223-229. Medline
II Neutral (Yellow) Correct placement detection Process OR Puntervoll SA., Soreide E., Jacewicz W., Bjelland E. Rapid detection of oesophageal intubation: take care when using colorimetric capnometry. Acta Anaesthesiol Scand 2002; 46(4):455-457. Medline
III Supportive (Green) Accurate detection Process OR McLeod GA., Inglis MD. The MiniCAP III CO2 detector: Assessment of a device to distinguish oesophageal from tracheal intubation. Arch Emerg Med 1992; 9(4):373-6. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline

Quantitative ETCO2 (no circulation)
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Effectiveness of intubation confirmation Process ED-MD Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001; 20(3):223-229. Medline
II Neutral (Yellow) Sensitivity and Specificity of detecting Esophageal intubation Patient ED-MD Takeda T., Tanigawa K., Tanaka H., Hayashi Y., et al. The assessment of three methods to verify tracheal tube placement in the emergency setting. Resusc 2003; 56(2)153-7. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline

Quantitative ETCO2 (with circulation)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hypoventilation Patient PH-MD & CCT Helm M., Schuster R., Hauke J., Lampl L. Tight control of prehospital ventilation by capnography in major trauma victims. Br J Anaesth 2003; 90(3):327-32. Medline
II Supportive (Green) Intubation success, Oxygen saturation Process PH-Paramedic Davis DP., et al. Predictors of intubation success and therapeutic value of paramedic airway management in a large, urban EMS system. Prehosp Emerg Care 2006; 10:356-62. Medline
II Supportive (Green) Equipment malfunction Process PH-Paramedic Kober A., Schubert B., Bertalanffy P., Gorove L., Puskas T., Gustorff B., et al. Capnography in non-tracheally intubated emergency patients as an additional tool in pulse oximetry for prehospital monitoring of respiration. Anesth Analg 2004; 98(1):206-10. Medline
II Supportive (Green) Sensitivity and Specificity of detecting Esophageal intubation Patient ED-MD Takeda T., Tanigawa K., Tanaka H., Hayashi Y., et al. The assessment of three methods to verify tracheal tube placement in the emergency setting. Resusc 2003; 56(2)153-7. Medline
II Neutral (Yellow) Effectiveness of intubation confirmation Process ED-MD Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001; 20(3):223-229. Medline
II Neutral (Yellow) Correct placement detection Process OR Puntervoll SA., Soreide E., Jacewicz W., Bjelland E. Rapid detection of oesophageal intubation: take care when using colorimetric capnometry. Acta Anaesthesiol Scand 2002; 46(4):455-457. Medline
II Opposes (Red) Survival Patient PH-Paramedic Wirtz DD., Ortiz C., Newman DH., Zhitomirsky I. Unrecognized misplacement of endotracheal tubes by ground prehospital providers. Prehosp Emerg Care 2007; 11:213-8. Medline
X Not Yet Graded (White) - Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon April 2024; 10(7):e28479. Medline


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