Clinical Assessment: Intraoperative Neuromonitoring Products & Universal Compatability

December 1, 2021

EMG ET Tube Electrodes Function And Compatibility For RLN Nerve Monitoring And Interoperability.

EMG tube EMG Electrode for universal IONM

Neuromonitoring Products And Device Interoperability

Numerous EMG nerve monitoring ET tubes and accessories continue to enter the Healthcare Market. Intraoperative neuromonitoring (IONM) based on electromyography (EMG) is a recent advancement for real-time nerve identification and monitoring of laryngeal and other vital nerves during surgeries1.

Neurovision Medical Products has been creating standard ET Tubes and integrating them with patented atraumatic EMG electrodes since 1973 to create universal intraoperative neuromonitoring products. Physicians utilize the EMG electrodes to serve as an additional safety measure in maintaining nerve integrity. As surgery techniques advance and integrate innovative surgical procedures, companies create more intelligent technology that can be used interchangeably and universally. Thus, universal interchangeable technology does not constrain hospitals and surgeons in a “one brand only” product monopoly.

However, the most significant indication that speaks to the reliability and superiority of NMP products lies in the evidence-based testaments. Below is a clinical assessment study that speaks about clinicians who work with the products every day.

Interoperable: Compatability And Function Of EMG Tube Electrodes In Clinician Use.

EMG Electrodes for Thyroid Surgery
EMG Electrodes, Cobra and Dragonfly, RLN Monitoring

Mike Demarco, R. EP T., CNIM is an experienced IOM clinician, who has over 30 years of experience working in Intraoperative Monitoring and neuro-diagnostic healthcare. Having monitored over 6,000 procedures, Mr. Demarco has practiced at some of the most distinguished medical centers in the country, such as Cedars Sinai Medical Center.

As a highly experienced neurophysiologist, he has found NMP IOM products to be comparable to competitors in many ways. In terms of functionality and compatibility, NMP products are superior to other IOM products. He participated in a study to discuss how universal and easy-to-use NMP products were in the surgery room.

The atraumatic electrodes were safe and effective on any platform and provided optimal ET tube placement for reliable RLN nerve monitoring”

– Mike Demarco, R. EP T., CNIM. (2019)

Clinical Assessment: Introperative Neuromonitoring With NMP EMG Tube Electrodes And Other IONM Systems

Mr. Demarco noted that his clinical routine in the OR did not need to be updated when using the Cobra ET Tube or any other NMP device. He commended NMP's innovative technology’s ability to work above average with other intraoperative neuromonitoring machines such as the Cadwell Cascade, the Medtronic Nerve Integrity Monitor (NIM) 2.0, and intermittent use of Medtronic NIM Spine for thirteen years. In addition to some minor experience with Medtronic NIM 3.0. Read the full assessment here.

Medical device platforms and accessory interoperability are widespread in many other clinical modalities. For instance, it is common to use different monopolar and bipolar devices in electrosurgery. These may be products that the electrosurgical platform vendor may not manufacture. Similarly, another example would be laser probes and light pipes. Companies such as Bausch and Lomb (Synergetics) and Alcon (Infinitec) have been used with HGM and Coherent lasers for years. This demonstrates a very long history of successful interoperability. The Universal ability of these products is consistent with Mr. Demarco’s and other clinicians’ experiences when using NMP devices and accessories across different IOM systems.

Designed For The Future Of Intraoperative Neuromonitoring Products: Cobra 3-Plate EMG Tube

NMP is constantly upgrading and advancing its current technology to best-fit patient safety and surgeon need. The Cobra 3-Plate EMG ET Tube is one of the groundbreaking new upgrades to their Cobra EMG monitoring devices line used by Mr. Demarco. The redesigned EMG tube uses color-coded wires that identify the lateral and posterior plates and increase the surface area to improve contact with the vocal cords, even in longer airways or larger patients.

The Cobra 3-Plate, EMG ET tube is available in sizes 6, 7, 8 mm. Furthermore, it provides the same functional abilities as an ET Tube with integrated IOM technology to lower the risk of nerve damage and elevate surgeon capabilities. To conclude, the Cobra 3 Plate is a universal design with proven compatibility with the most common single-channel and multi-channel nerve monitoring systems.


Universal EMG electrode for intraoperative neuromonitoring of the vocal cords. Monitor RLN activity while maintaining an open airway for ventilation.

  1. Schneider R, Randolph GW, Dionigi G, et al. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 2018;128 Suppl 3:S1-17. [Crossref] [PubMed]