How should you confirm placement of an endotracheal tube during pediatric CPR?

• A. Use waveform capnography; confirm by capnography waveform and auscultation.
• B. Confirm placement by auscultation alone.
• C. Rely on bag valve return and chest movement.
• D. Wait for radiographic confirmation.

Answer: (A)

During pediatric CPR, confirm endotracheal tube placement with waveform capnography. A continuous capnography waveform indicating a measurable end-tidal CO2 confirms the tube is in the trachea, and this remains true even though CPR lowers overall pulmonary blood flow. If the tube were in the esophagus, little or no CO2 would be detected and there would be no reliable waveform, prompting repositioning. Auscultation alone is unreliable in the noisy, moving CPR setting and cannot be trusted as the sole method. Radiographic confirmation is too slow during ongoing resuscitation. So, capnography provides the fastest, most reliable confirmation, with auscultation used as a supplementary check.