Inaccuracy in endotracheal tube verification using a Toomey syringe

The Toomey syringe and other esophageal detection devices have been shown to be highly sensitive and specific for indicating whether an endotracheal (ET) tube is in the esophagus or the trachea. Many prehospital systems use the Toomey syringe method as the major determinant in deciding whether or not to remove an ET tube after an intubation attempt. We present three cases in which various pulmonary pathologies led to false positive results; that is, Toomey syringe aspiration indicated esophageal placement when the tube was correctly positioned in the trachea. A literature review follows the case reports.