Endotracheal Tube Placement Confirmation in Cardiac Arrest
Continuous waveform capnography is the most reliable method for confirming and monitoring correct endotracheal tube placement in adults with cardiac arrest. [1] Clinical assessment should be performed in addition to capnography. [1]
Recommended Confirmatory Method
- Use continuous waveform capnography with each ventilation cycle to confirm and monitor endotracheal tube position. [1]
- Interpretation should focus on the presence of an appropriate capnography waveform after each ventilation. [1]
Evidence Supporting Waveform Capnography
- Continuous waveform capnography has been shown to provide very high diagnostic performance for correct tube placement in cardiac arrest compared with non-capnographic methods. [1]
- An evidence-based guideline update for capnography/capnometry in mechanical ventilation recommends continuous-waveform capnography in addition to clinical assessment for confirming correct endotracheal tube placement. [2]
Comparison With Other Methods
- Auscultation findings and other purely clinical signs should not be used as the primary confirmation strategy for endotracheal tube placement in cardiac arrest when capnography is available. [1]
Backup When Waveform Capnography Is Unavailable
- If waveform capnography is not available, a non-waveform exhaled CO2 monitor should be used in addition to clinical assessment as the initial method for confirming correct tube placement in cardiac arrest. [2]
Ongoing Monitoring Requirement
- Capnography should be used not only for initial confirmation but also for continuous monitoring to detect loss of appropriate airway placement over time. [1]