Point-of-care ultrasound (POCUS) in emergency airway management: emerging evidence for assessment, prediction, and confirmation.

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Abstract

Effective airway management is essential in emergency medicine, where rapid patient deterioration and limited preparation time increase the risk of hypoxia, aspiration and cardiac arrest. Traditional bedside assessments and confirmation techniques such as Mallampati scoring, auscultation and capnography have notable limitations, particularly in patients with trauma, obesity, cardiac arrest or distorted anatomy. Point-of-care ultrasound (POCUS) has emerged as a reliable adjunct that provides real-time, non-invasive visualisation of airway structures, prediction of difficult laryngoscopy and rapid confirmation of endotracheal tube placement. This narrative review synthesises current evidence to evaluate the expanding role of airway POCUS in emergency practice. Ultrasound enables clinicians to identify key landmarks, including the cricothyroid membrane, trachea and epiglottis, and to measure parameters such as the distance from skin to epiglottis, pre-epiglottic space, tongue thickness and anterior-neck soft-tissue depth. Several of these predictors demonstrate a moderate-to-strong correlation with difficult laryngoscopy and provide greater objectivity than conventional airway assessments. For confirming tube placement, tracheal and lung ultrasound offer rapid, accurate differentiation between tracheal and oesophageal intubation. Signs such as lung sliding, lung pulse and diaphragmatic motion reliably confirm ventilation, even during cardiac arrest when capnography may be unreliable. Challenges persist, including operator dependency, equipment variability and lack of standardized measurement protocols. However, emerging innovations-including handheld ultrasound devices, AI-assisted landmark detection and simulation-based training-show promise for improving accessibility and consistency. Overall, airway POCUS enhances clinical decision-making and patient safety when integrated as an adjunct to established airway management techniques.

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