Accidental oesophageal intubation

The Sensitivity and Specificity of Transcricothyroid Ultrasonography to Confirm Endotracheal Tube Placement in a Cadaver Model

“…Subjects were given a 5-min briefing on how to identify the larynx on US by visualizing two hyperechoic laryngeal lines in a longitudinal (sagittal) plane ( Figure 1). Residents attempted to ultrasonographically visualize the "snowstorm" appearance between the two lines to signify an endotracheal intubation (9). The lack of this "snowstorm" through the double lines and the appearance of movement posterior to the two laryngeal lines served as evidence of an esophageal intubation.…”

“…As a result, capnometry has become the standard of care due to its ease of use and reliability (6 -8). However, its accuracy in cardiac arrest is unclear, and some data exist to suggest that up to six breaths may be required before the stomach is completely cleared of CO 2 , especially after prolonged bagvalve-mask ventilation (9). Ultrasonography (US) is rapidly becoming an indispensable and commonplace tool in the Emergency Department (ED).…”

Transtracheal 2-D Ultrasound for Identification of Esophageal Intubation

“…Unrecognized intubation of the esophagus is a significant source of morbidity and mortality (1). In as many as 8% of all attempts at emergency airway management, esophageal intubation has resulted (2).…”

Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians

“…E ndotracheal intubation is ''a potential minefield for disaster''. 1 Errors in its performance can be associated with high morbidity and mortality for the patient, and legal liability for the practitioner. Many methods exist for the verification of successful tube placement in the trachea, including watching the tube pass through the cords, pulse oximetry monitoring, and listening for breath sounds.…”