Confirmation of correct ETT placement in adults

Correct ETT placement should be confirmed with the presence of sustained exhaled CO₂ whenever possible.

For patients in cardiac arrest:

An ETCO₂ value <7.5 mmHg or a complete lack of exhaled CO₂ should be presumed to represent esophageal intubation even in patients with prolonged cardiac arrest; the ETT should be removed and the patient should be ventilated by mask or with an SGA.
If using a colorimetric CO₂ detector, color change may not occur in approximately 30% of correct tracheal ETT placements. In general, lack of color change should be presumed to represent esophageal intubation, but subsequent management is a clinical judgement.

This algorithm should be used in conjunction with UpToDate content on confirmation of correct endotracheal tube placement.

CO₂: carbon dioxide; EtCO₂: end-tidal carbon dioxide; ETT: endotracheal tube; SGA: supraglottic airway.

* With tracheal ETT placement the peak amplitude or EtCO₂ is usually >15 mmHg. However, CO₂ values between 7.5 to 15 mmHg may occur in the setting of cardiac arrest, low cardiac output, and shock. The CO₂ waveform should rise and fall with the breathing cycle regardless of the peak or end-tidal CO₂ value.

Graphic 144613 Version 1.0

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Confirmation of correct ETT placement in adults