Evidence map›Paper›PMID 35977431›Full record

GuidelineAnaesthesia2022

Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies.

N Chrimes, A Higgs, C A Hagberg, P A Baker, R M Cooper, R Greif, G Kovacs, J A Law, S D Marshall, S N Myatra and 6 more

Registry-linked trialOpen access · hybridAbstract readPractice Guideline
PubMed Publisher
In one paragraph

Guideline in Anaesthesia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07624162 (Practicability of Airway Management With the Videolaryngoscopes I-scoop and C-Mac D-Blade Under Spontaneous Breathing and Analgosedation - A Prospective, Randomized, Monocentric Trial), which is not on this map. Cited by 64 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 5 pooled it
44.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07624162 narecruitingnot on this mapstarted 2026, after this paper: background citation

Practicability of Airway Management With the Videolaryngoscopes I-scoop and C-Mac D-Blade Under Spontaneous Breathing and Analgosedation - A Prospective, Randomized, Monocentric Trial

TypeinterventionalSponsorHannover Medical SchoolRan2026 to 2028Enrolled200ConditionsAirway ManagementArmsAirway management under spontaneous breathing with the i-scoop videolaryngoscope, Airway management under spontaneous breathing with the C-Mac D-Blade videolaryngoscope
3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 5 syntheses or guidelines pooled it, 191 citations in OpenAlex.

  1. Guideline
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Guideline
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Article
  11. Review
  12. Article
  13. Article
  14. Point-of-Care Ultrasound in Airway Management.Journal of clinical medicine · 2026
    Review
  15. Article
  16. Article
  17. Ten tips for a safe approach in airway management.Journal of anesthesia, analgesia and critical care · 2026
    Review
  18. Observational
  19. Review
  20. Article

4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 15 institutions in 10 countries.

N ChrimesDepartment of Anaesthesia, Monash Medical Centre, Melbourne, Australia.ORCID 0000-0003-4827-3764
A HiggsDepartment of Anaesthesia and Intensive Care, Warrington Teaching Hospitals NHS Foundation Trust, Cheshire, UK.
C A HagbergDepartment of Anaesthesiology and Peri-operative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
P A BakerDepartment of Anaesthesiology, University of Auckland, New Zealand.
R M CooperDepartment of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada.
R GreifDepartment of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland.
G KovacsDepartments of Emergency Medicine, Anesthesia, Medical Neurosciences and Division of Medical Education, Dalhousie University, Halifax, Canada.
J A LawDepartment of Anesthesia, Pain Management and Peri-operative Medicine, Dalhousie University, Halifax, Canada.
S D MarshallDepartment of Critical Care, University of Melbourne, VIC, Australia.
S N MyatraDepartment of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
E P O'SullivanDepartment of Anaesthesiology, St James's Hospital, Dublin, Ireland.
W H RosenblattDepartment of Anesthesia, Yale School of Medicine, New Haven, CT, USA.
C H RossDepartment of Emergency Medicine, Mercy Health, Javon Bea Hospital, Rockton and Riverside Campuses, Rockford, IL, USA.
J C SaklesDepartment of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
M SorbelloAnesthesia and Intensive Care, AOU Policlinico San Marco University Hospital, Catania, Italy.
T M CookDepartment of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Dalhousie University · CAHomi Bhabha National Institute · INIllinois College · USMarconi University · ITMonash Medical Centre · AUSigmund Freud Privatuniversität Wien · ATSt. James's Hospital · IEThe University of Melbourne · AUThe University of Texas MD Anderson Cancer Center · USUniversity of Arizona · USUniversity of Auckland · NZUniversity of Bristol · GBUniversity of Toronto · CAWarrington and Halton Teaching Hospitals NHS Foundation Trust · GBYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occur in the hands of both inexperienced and experienced practitioners. Current evidence shows that unrecognised oesophageal intubation occurs sufficiently frequently to be a major concern and to merit a co-ordinated approach to address it. Harm from unrecognised oesophageal intubation is avoidable through reducing the rate of oesophageal intubation, combined with prompt detection and immediate action when it occurs. The detection of 'sustained exhaled carbon dioxide' using waveform capnography is the mainstay for excluding oesophageal placement of an intended tracheal tube. Tube removal should be the default response when sustained exhaled carbon dioxide cannot be detected. If default tube removal is considered dangerous, urgent exclusion of oesophageal intubation using valid alternative techniques is indicated, in parallel with evaluation of other causes of inability to detect carbon dioxide. The tube should be removed if timely restoration of sustained exhaled carbon dioxide cannot be achieved. In addition to technical interventions, strategies are required to address cognitive biases and the deterioration of individual and team performance in stressful situations, to which all practitioners are vulnerable. These guidelines provide recommendations for preventing unrecognised oesophageal intubation that are relevant to all airway practitioners independent of geography, clinical location, discipline or patient type.

Indexed as

Carbon DioxideIntubation, IntratrachealAirway ManagementCapnographyEsophagusHumansCarbon Dioxideairway managementcapnographyhuman factorsoesophageal intubationtracheal intubation

Identifiers

PMID35977431
OpenAlexW4292340142

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.