Currently, the “gold standard” of confirmation of tracheal tube placement is direct visualization of the endotracheal (ET) tube passing through the vocal chords and observation of the chest rising and falling with ventilation. However, visual depth into the patient’s upper airway can often be severely limited due to their clinical condition, such as maxillofacial trauma or swollen features, or due to the geometry of their innate anatomical characteristics, such as prominent teeth or short necks. These challenges, generally categorized as a “difficult airway,” have been documented to occur in the prehospital environment as much as 50% of the time and pose problems for standard intubation and visual confirmation techniques.6,7 Presently, end-tidal carbon dioxide monitoring () exists as a nonvisual method of confirmation for ET placement and can be captured using a few approaches: colorimetry, capnography, or capnometry. The colorimetric approach involves a single-use device with chemical sensitive paper that changes color with the detection of .8 When regarded for the prehospital environment, reports have found the colorimetric method subjective and slow as it requires several breathes to allow enough exposure for color differentiation, which is not always sufficiently available during the event of cardiac arrest.9,10 Studies have also reported false positives when the patient has previously been exposed to mouth-to-mouth resuscitation or if the sensor has been exposed to acidic contents or drugs, such as gastric contents or lidocaine, both of which are common in the prehospital setting.10,11 Furthermore, colorimetry does not provide continuous patient monitoring to ensure proper tracheal tube placement once intubated. Displacement of the tracheal tube can result from patient movement, which can easily go undetected amidst the typically chaotic prehospital, ICU, and emergency department environments, thereby leading to the same serious adverse events of failed airway management.12 Due to these limitations, some guideline documents have formally discouraged the use of the colorimetric approach for prehospital intubation confirmation. On the other hand, capnography involves the monitoring of the waveform measuring instantaneous in the expired breath by detecting the change in the relative absorption of infrared light shined through the ET. Correspondingly, capnometry includes the monitoring of the numerical output captured by the capnography. Both capnography and capnometry have been largely correlated with diagnostic benefits as well as ET confirmation.9–11 Despite its clinical efficacy and suggested benefit, a recent survey of emergency physicians showed only 25% of sites possess continuous monitoring capabilities. This dramatic lack of availability of the technology contrary to its recommendation from professional societies suggests that the instrumentation is too expensive or too much of a hindrance to prehospital care.13 Additionally, all of the current methods require the provider to stop care to perform the confirmation or they require additional specialized equipment that is not always readily available. In a prehospital or emergency setting, time is critical and providers often cannot afford to stop care to perform or wait for confirmatory procedures.