Impact of Point-of-Care Ultrasound on Emergency Airway Management

Abstract

Point-of-care ultrasound has become an increasingly common bedside adjunct for airway management in the emergency department and intensive care unit, where patients are frequently unstable, unstarved, and difficult to assess by physical examination alone. This review synthesizes the evidence for four principal applications: sonographic prediction of a difficult airway, ultrasound-guided identification of the cricothyroid membrane for surgical airway access, ultrasound confirmation of endotracheal tube position and depth, and gastric ultrasound for aspiration risk stratification. Diagnostic accuracy data for tracheal-versus-esophageal tube placement confirmation are the most robust, with pooled sensitivity and specificity consistently above 90% across multiple meta-analyses, including during cardiac arrest when capnography can be unreliable. Evidence for pre-intubation difficulty prediction and cricothyroid membrane localization is more nuanced, supporting ultrasound as a valuable adjunct to standard assessment and as an anticipatory tool in high-risk patients rather than as a standalone or purely real-time crisis intervention. We conclude that point-of-care ultrasound has a defensible and expanding role in emergency airway management, while noting that most supporting evidence remains diagnostic-accuracy and simulation-based rather than derived from large outcome trials.