‘No trace, wrong place’ does not mean ‘positive trace, right place’. Identifying and managing misplaced or displaced tracheal tubes in cardiopulmonary resuscitation

Why does oesophageal intubation still go unrecognised? Lessons for prevention from the coroner’s court

“…Misting of the tracheal tube, bilateral chest movement and breath sounds on auscultation do not in themselves, or even collectively, robustly confirm correct tube position (and hence must be discounted as confirmatory). However, their absence should heighten concern, and act as further prompt to recheck capnogaphy in a scheme outlined elsewhere [5].…”

“…In others, there is a false assumption that during cardiopulmonary resuscitation (CPR) a flat trace is to be expected even with correct placement [4]. This assumption is wrong: carbon dioxide traces can be elicited from tracheal tubes even in cadavers, and the value of end‐tidal carbon dioxide with CPR can predict successful resuscitation [5]. This has been the basis of the Royal College of Anaesthetists’ ‘ no trace = wrong place ’ campaign [6].…”

Unrecognised oesophageal intubation: importance of identifying the issues

“…We thank Drs Dob and Norman for their comments [1] on our editorial [2] but we think they may have conflated several different issues in relation to tracheal tube placement. We had hoped an earlier article would have clarified and so pre‐empted the sort of queries they raise [3].…”

“…This is apparently counter to the slogan being promoted by the Royal College of Anaesthetists: ‘no trace, wrong place’. However, the propositional logic around these two statements, both equally true, was addressed in a recent article [3].…”

Human factors and clinical assessment: issues in confirming correct tracheal tube placement

“…Clinical examination is, or ought to be, part of a ritual that culminates in checking the capnograph and verbalising the result. It is also essential because, as discussed elsewhere, 'no trace, wrong place' does not mean 'positive trace, correct place' [5]. There are many life-threatening scenarios where, despite a positive carbon dioxide trace, the tube is misplaced and this requires clinical assessment.…”