Unrecognized Esophageal Intubation: Prevention, Recognition Management

Unrecognized esophageal intubation (UEI) continues to occur. This causes avoidable mortality and severe morbidity. Traditionally, operators have relied on simple manoeuvres and one-line aphorisms to teach students how to avoid it. These have not always proven successful and tragic deaths still occur. In some jurisdictions, Coroners are exerting significant pressure on anesthetic authorities to eliminate this complication. The international, multi-disciplinary group, the Project for the Universal Management of the Airway (PUMA), in conjunction with the main specialist airway societies around the world, have produced a straightforward, systematic guideline focused on avoiding UEI. This article reviews why UEI deaths happen and how the new guideline approaches this issue which will be of interest to all airway practitioners, independent of specialty or seniority.