Continuous capnography showing a sustained waveform (ETCO2) is the most reliable method for confirming endotracheal tube placement in patients with spontaneous circulation. It directly measures CO2 exhaled from the lungs, indicating tracheal placement. While auscultation, condensation, and chest X-ray are supportive, they can be misleading. Auscultation can pick up transmitted sounds from esophageal intubation, condensation can occur with esophageal intubation, and a chest X-ray confirms position but is not real-time and does not confirm ventilation.
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