I am researching methods of confirming proper endotracheal intubation,
meaning how does the emergency technician or doctor know that they
have inserted the tube through the mouth down into the trachea (the
large airway from the mouth to the lungs) and NOT into the esophagus? 
As I understand, there are different methods to do this, such as
capnography (CO2 monitoring) and EDDs (esophageal detector devices)
that include a self-inflating bulb and aspiration syringe.  Another
article mentions current methods include direct visualization and
radiographic assessment.
 
I need to know the names of companies that make such equipment, and
would like to know five companies in each category. In other words, I
would like to know five additional companies that make capnography
devices (not including Oridion, which I already know), plus five
additional companies that make esophageal detector devices (not
including Ambu, Nanoptics, and ARC Medical, which I already know).  I
would also like to know at least three companies that make the direct
visualization devices.
 
If you have any additional information that you think would be
valuable as I research this important area, it will be extremely
helpful, and I will be happy to pay a tip.  I am preparing a training
class and need to make certain that all the different products are
included and described.  I will do more research after I know the
names of all the companies.

---

Clarification of Question by hovig-ga on 01 Mar 2004 22:17 PST

Hi there,

Thank you so much for taking the time to answer my question. I just
wanted to say that in case there aren't five companies in one category
? please give me whatever you can find.  It just seems like there are
lots of companies, and I do not want to miss any.  Maybe you could
find one of those lists of companies in the reports or something like
that... Again, thank you for your help!!!  It is much
appreciated?..Thanks ? Lucy

Hello, hovig (Lucy)!

 I was just about to post my answer when I saw your clarification.
This took quite a long time because I was having a difficult time
finding five manufacturers of EDD's. There are not many manufacturers
to choose from in that area, as I have described below. I did manage
to find several different manufacturers for Capnography devices, as
well as some manufacturers of visualization devices. While there are
many different suppliers of intubation products, most carry products
from the same manufacturers.

 Though my search was very thorough, there may be companies in other
countries that manufacture some similar intubation products. If you
would like me to conduct further research in a follow-up question, I
will be happy to do so.

  

*********************
CAPNOGRAPHY DEVICES
*********************

RGB Medical Devices
=====================
http://www.rgb-medical.com/

Omnicron Altea Modular Monitor
(To view, click on "Products" and click on "Modular")



Spacelabs Medical
==================
http://www.spacelabs.com/index.html

Mainstream 90516 Capnograph Module:

"Eliminates a standalone capnograph and provides ETCO2, minimum CO2,
O2 and respiration rate monitoring. It has self-calibrating operation
which simplifies use, saves time and ensures highly accurate results.
By using the module in a Spacelabs Medical transport monitor, ETCO2
data can be captured during the patient transfer process."
http://www.spacelabs.com/products/modules.html#capnography

Contact:
http://www.spacelabs.com/company/worldwide.html



Welch Allyn OEM Technologies
=============================
http://www.oem.welchallyn.com/

LC101:
"The LC101 module is the ideal choice for cost-conscious product
developers seeking to add sidestream CO2 measurement capability to
their product at an affordable price."
 
DUET:
"The DUET module provides the utmost flexibility in system
configuration. DUET can be configured as a sidestream module, or with
the addition of our mainstream sensor, DUET can perform mainstream
measurement functions. For those seeking the utmost in performance,
DUET can provide both mainstream and sidestream capability with a
single board."

Contact:
Welch Allyn OEM Technologies
8500 SW Creekside Place
Beaverton, OR 97008-7107
Phone: 503-530-7900
Fax: 503-526-4901



CardioPulmonary Technologies, Inc.
===================================
http://www.cpt-inc.com/index.htm

Capnography Products:
http://www.cpt-inc.com/capno/capno.htm

Contact:
CardioPulmonary Technologies, Inc.
N56 W24790 N. Corporate Cir.
Unit C
Sussex, WI  53089
Phone:  (001)-262-820-1294



Novametrix Medical Systems
==========================
http://www.novametrix.com/

Capnogrophy Products
http://www.novametrix.com/nova/ix_cap.html

Contact:
Novametrix
5 Technology Drive 
Wallingford, CT 06492-1926 
Telephone - Corporate Office 203-265-7701



Pulmolink
=========
http://www.pulmolink.co.uk/index.html

Capnography Products:
http://www.pulmolink.co.uk/Capnographs.htm
 8400 CAPNOCHECK II
 9004 Capnocheck® Plus 
 8200 Capnocheck

Contact:
Redwood House,
Canterbury Road
Charing
Ashford
Kent
TN27 0EU
e-mail -sales@pulmolink.co.uk
Telephone -01233 713070
Fax -01233 713859



Thames Medical
===============
http://www.thamesmedical.com/

Capnography Products:
http://www.thamesmedical.com/emscapnographyframeset.html

Contact:
Thames Medical
Thames House
16 Brook Barn Way
Goring by Sea
Worthing, West Sussex, BN12 4DW
Tel: +44 1903 522911 
Fax: +44 1903 522922



******************************
ESOPHAGEAL DETECTOR DEVICES 
******************************

 Manufacturers of Esophageal Detector Devices which prevent
regurgitation and allow for more probable insertion into the trachea
as opposed to the esophagus do not have a wide selection of
manufacturers. The "Tube-Chek" by AMBU (which you already found) is a
popular device which pops up on many supply sites. The only other
similar products I could find from different manufacturers were the
The Positube and the BAAM Airway Monitor. There are two other products
which are more advanced and make intubation possible even with
incorrect insertion. These are the trademarked PTL Airway and the
Combitube Airway. These last two devices provide effective airway
management whether insertion is into the trachea or the esophagus.

 I have provided links to these EDD products below. Although I have
combined them with a supplier, most of these products are available
from numerous companies.

 You may also want to read the following article as a "preview":

"Prehospital Airway Devices," by Guy H Haskell, PhD, NREMT-P. Last
Updated: April 26, 2002 http://www.emedicine.com/emerg/topic705.htm


 
Positube
=========

PosiTube Oesophageal Intubation Detection Device;
 
"With PosiTube, you can immediately verify proper placement of the
endotracheal tube or double lumen airway. You can then oxygenate your
patient with confidence."

Available from SP Services
http://www.spservices.co.uk/brands/positube/positube.htm

Contact:
SP Services (UK) Ltd 
Unit D4, Hortonpark Estate 
Hortonwood 7, Telford 
Shropshire, TF1 7GX, UK 
Telephone: (44) 0 1952 288 999
Fax: (44) 0 1952 606 112 
E-Mail: sales@spservices.co.uk



BAAM Airway Monitor
====================

"The Beck Airway Flow Monitor (BAAM) is a disposable device that
magnifies the patients respirations with a whistle sound. Simply
attach the BAAM to the end of an ET tube to assist you with correct
tube placement, blind nasotracheal intubation, and to monitor the
status of an airway. If you hear a whistle sound you know that there
is air moving through the device. If there is no whistle sound it
means the tube is in the wrong place or the trachea is obstructed. The
BAAM can also provide different whistle pitches depending on how
strong the respiratory effort is."

Available from http://www.buyemp.com/dept.asp?dept%5Fid=1011004



PtL® (Pharyngeo-tracheal Lumen) Airway
====================================== 
"The latex free PtL® (Pharyngeo-tracheal Lumen) Airway gives you and
your patient all those advantages the first time you insert it.
Insertion is as easy as possible, requiring only minimal skill. Even
head trauma cases can be successfully intubated using the chin-lift
method, without the danger of cervical manipulation. The airway works
whether you intubate the trachea or esophagus. In the esophagus, it
provides volume efficiencies comparable to an endotracheal tube (ETT).
Unlike an esophageal obturator airway (EOA), the PtL® Airway does not
require a tight face mask seal, so it can be used in facial trauma and
burn cases. And it helps protect the trachea from upper airway
hemorrhage and secretions; the EOA can't."
http://www.gettig.com/ptl.html

Contact:
Gettig Pharmaceutical Instrument Company 
1 Streamside Place West 
Spring Mills, PA 16875 
Telephone - (814) 422-8892 
Fax - (814) 422-8011 
Email - ptl2@gettig.com 



Kendall-Sheridan COMBITUBE AIRWAY
===================================
* Blind placement without laryngoscope. 
* Unique design provides patent airway with either esophageal or tracheal 
  placement  
* Reduces risk of aspiration of gastric contents. 
http://www.life-assist.com/combitube.html


* Read:

"The Esophageal Tracheal Combitube Revisited,, 5 Things You May Not
Know," by Bob Mayberry. Air Fax (August 2002)
http://aircare.org/pdfs/50.pdf



*****************************
DIRECT VISUALIZATION DEVICES
*****************************

GlideScope® Video Intubation System (Vitaid) 
---------------------------------------------  
"The GlideScope® is a new and safer video intubation system. By
providing an unobstructed view of the vocal cords, the GlideScope® is
ideal for many types of intubations. A high resolution video camera is
embedded within the laryngoscope style blade. A clear image is
captured by the camera and displayed on a 7" LCD monitor screen. An
LED light source mounted beside the camera provides continuous
illumination during the intubation. The blade of the GlideScope® video
intubation scope bends 60° at the mid-line. No wider than 18mm at any
point, the GlideScope® can easily enter the patient's mouth."
http://www.keomed.com/product.asp?dept_id=6396&pf_id=2673&mscssid=31H9PAPTGJS12MJK00L447M7VT66EMUW

(Vitaid)
http://www.vitaid.ca/



UpsherScope (Mercury Medical) 
==============================
"When you're challenged with a difficult intubation, the new
Mercury/UpsherScope can help address the situation by improving
visualization of a difficult airway. With the use of advanced fiber
optics and an easy-to-focus eyepiece, it allows you to watch the
endotracheal tube as you guide it between the vocal cords."
http://www.keomed.com/product.asp?dept%5Fid=6396&pf%5Fid=2308

(Mercury Medical)
http://www.mercurymed.com/



FAST Flexible Airway Scope Tool (Clarus Medical Systems)
===========================================================
"Portable, malleable, fiber optic scope for visualization while intubating..."
http://www.keomed.com/product.asp?dept%5Fid=6396&pf%5Fid=2618

(Clarus Medical Systems)
http://www.clarus-medical.com/airwaymanagement.htm



Shikani Seeing Stylet (Clarus Medical Systems)
===============================================
"Optimum visualization and illumination for management of the
difficult airway. Easy hand adjustment of stylet shape provides the
capability of more expensive instruments. Superior clarity and
detail."
http://www.keomed.com/product.asp?dept%5Fid=6396&pf%5Fid=926&mscssid=31H9PAPTGJS12MJK00L447M7VT66EMUW

(Clarus Medical Systems)
http://www.clarus-medical.com/airwaymanagement.htm



Lightwand Intubation
====================
"Lighted stylettes rely upon transillumination of the anterior neck
tissues to demonstrate laryngeal placement. A well-circumscribed glow
indicates tracheal intubation, whereas a diffuse glow is seen with
esophageal placement."
http://www.airwaycarnival.com/LWI.htm




*****************
Reading Material
*****************

"The efficacy of esophageal detector devices in verifying tracheal
tube placement: a randomized cross-over study of out-of-hospital
cardiac arrest patients." Tanigawa K, Takeda T, Goto E, Tanaka K.
Anesth Analg. 2001 Feb;92(2):375-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11159235&dopt=Abstract

"Comparison of a Colorimetric End-Tidal CO2 Detector and an Esophageal
Aspiration Device for Verifying Endotracheal Tube Placement in the
Prehospital Setting: A Six-Month Experience," by Richard J. Schaller
MD,1 J. Stephen Huff, MD, FACEP,2 Allan Zahn, MD3. Prehospital and
Disaster Medicine 1997; 12(1):57-63.
http://pdm.medicine.wisc.edu/schaller.htm

"The Esophageal Detector Device: Summary of the current articles in
the literature." Compiled by Tim Wolfe, M.D.
http://www.wolfetory.com/education/eddab.html

"Oesophageal Detector Devices," by Dr. RP Haridas. Equipment. Issue 7
(1997) Article 6: Page 1 of 1
http://www.nda.ox.ac.uk/wfsa/html/u07/u07_016.htm

"ACEP Announces News Policy for Verifying Patients Are Intubated Correctly."
July 18, 2002 http://www.acep.org/1,5357,0.html 

"Is the esophageal detector device or end-tidal CO2 measurement
superior in confirming endotracheal tube placement?" Canadian Journal
of Emergency Medicine. Vol. 1, No 2, July 1999
http://www.caep.ca/004.cjem-jcmu/004-00.cjem/vol-1.1999/v12-103.htm

"Confirming proper intubation in the emergency setting." A summary of abstracts
http://www.wolfetory.com/education/confirming_proper_intubation.htm

'Portable devices used to detect endotracheal intubation during
emergency situations: a review." Cardoso MM, Banner MJ, Melker RJ,
Bjoraker DG. Crit Care Med. 1998 May;26(5):957-64.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9590328&dopt=Abstract


========


 I hope this information is helpful. Again, if you have further
information that you would like me to pursue at a later date, I would
be happy to do so!

umiat-ga 

Google Search Strategy
Capnography devices +manufacturers
esophageal detection devices
intubation detection devices
esophageal intubation detector
airway devices
intubation products
EDD devices +manufacturers
intubation visualization devices

---

Request for Answer Clarification by hovig-ga on 02 Mar 2004 00:21 PST

Umiat, thank you very much for your hard work. Your answers are a big
help! A couple of things I wanted to clarify: I noticed that under
EDDs, some of the products (like Positube, BAAM Airway Monitor,
Kendall-Sheridian Combitude Airway) only provide links to product
distributors and not manufacturers. Is it because there is no
information on who manufactures the product? Also - and I'm sorry if I
wasn't clear in my question - is radiographic assessment part of
capnography, or EDDs, or direct visualization or is it a separate
stand-alone method for confirming endotracheal intubation? And if it
is separate, would you be able to provide me with the names of
products and manufacturers - whatever you can find?

Many thanks,
Lucy

---

Clarification of Answer by umiat-ga on 02 Mar 2004 09:14 PST

Hello again, Lucy!

I am sorry I omitted the manufacturer's names for the following
equipment. Here they are:


The Positube is manufactured by Paraproducts:
http://www.paraproducts.com/

Contact Info:
400 Industrial Drive
South Elgin, IL 60177 
Phone:  (847) 888 - 1919
Fax:  (847) 888 - 5566
http://www.paraproducts.com/contact.htm

==

The BAAM (Beck Airway Airflow Monitor) is manufactured by Great Plains
Ballistics (see following article)
http://fred.hmc.psu.edu/ds/retrieve/fred/publication/8217182

Great Plains Ballistics Inc (no website found)
7427 Highway 1 South
Donaldsonville, LA 70346 
(225) 746-0608 

==

The Kendall-Sheridan Combitube Airway is manufactured by Kendall-Sheridan.
 
The Kendall Sheridan Catheter Corp (no website found)
5439 State Route 40
Argyle NY 12809 
phone: (518) 638-6101  fax: (518) 638-8493 
description: Medical Instruments and Supplies 


==


As far as Radiographic Imaging for intubation is concerned, that is an
entirely different ballgame than Capnography. Capnography measures
exhaled CO2. It is not taking a picture of the airway.

* Radiographic imaging would be used in a hospital setting to
determine correct placement of an endotracheal tube.

* I have not run across any references that indicate the existence of
"specific" X-ray machines manufactured "solely" for the purpose of
determining correct endotracheal tube placement.

The following case study highlights how a chest x-ray revealed the
faulty placement of an endotracheal tube:

"Delayed recognition of esophageal intubation," by Kenneth C.
Dittrich, MD. Canadian Journal of Emergency Medicine. Vol. 4, No 1,
January 2002.
http://www.caep.ca/004.cjem-jcmu/004-00.cjem/vol-4.2002/v41-041.htm

=

You might also want to read "Intubation."
http://health.discovery.com/encyclopedias/1219.html

Once the tube has been inserted: 

* it is attached to a bag that can be squeezed to deliver breaths to the person
 
* its placement will be checked by listening for airflow sounds over the lungs 

* a chest X-ray will be taken to confirm that the tube is in the right place 

== 

The following article may also be of interest:

"REFLECTOMETRY CAN IMPROVE ENDOTRACHEAL TUBE PLACEMENT." Pulmonary
Reviews. Vol. 8, No. 3.
(March 2003) http://www.pulmonaryreviews.com/mar03/pr_mar03_endotracheal.html

"Standard methods for confirming placement of an endotracheal tube
(ETT) include direct visualization, radiographic assessment, and
capnography. However, direct visualization is not always possible,
radiographic studies cannot always be rapidly performed, and results
of end-tidal capnography may be unreliable when the pulmonary
circulation is disrupted, as occurs in cardiopulmonary arrest. In a
recent study, a newly developed rapid acoustic method identified 99%
of correctly placed ETTs and 100% of misplaced (esophageal) tubes."

(Read more...)


==


So, to sum it up, you are looking at a range of devices that are used
to facilitate correct placement of an airway device in a field
setting.....all the way to the ability to use x-ray imaging to
determine correct placement in a hospital setting.

Does that make sense?


umiat

---

Request for Answer Clarification by hovig-ga on 02 Mar 2004 10:33 PST

Dear Umiat, thank you again for your answers and great work. I will
provide a tip for the excellent answers that you furnished.
 
This is the first time I have posted a question on Google Answers, so
I am not certain what is the right format.  In addition to the
information you provided, I am interested in the international
companies that manufacture some intubation products.  What I am MOST
interested in is really BRAND NEW products that are just in the early
development stage ? like the things that some of the universities are
working on?..or are being presented at research type meetings.  One
thing would be an abstract that would be published on really early
things.  If I want to ask you to help with that, since you already did
some research and found some good information, how do I address the
question to you?  I think it would be better to have you answer, since
you already did some good research.  Please let me know.  Thanks  -
Lucy

---

Clarification of Answer by umiat-ga on 02 Mar 2004 13:52 PST

Hi, Lucy,
 Thank you very much for your generosity.
 I would be happy to work on further questions for you. All you need
to do is post "For Umiat" in the question heading and I will be sure
to see it.
 I will be out of town for a few days starting tomorrow afternoon, so
you can post a further question as soon as you want and I can begin
working on it. Be assured I will be working even if you do not see it
locked. If you are okay with waiting a few days for an answer, that
will work perfectly (unless you post it today and I can finish it up
before I go) Either way, I will be here.
 Thanks again for your kind words and generous tip!
umiat

Thank you very much for your excellent answers and thorough work.