Updates in emergency airway management

• Published in: Current opinion in critical care Vol. 24; no. 6; p. 525
• Main Authors: Carlson, Jestin N, Wang, Henry E
• Format: Journal Article
• Language: English
• Published: United States 01.12.2018
• Subjects: Airway Management - methods; Airway Management - trends; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - trends; Emergency Medical Services - trends; Humans; Intubation, Intratracheal; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - physiopathology; Out-of-Hospital Cardiac Arrest - therapy; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome
• ISSN: 1531-7072
• DOI: 10.1097/MCC.0000000000000552

Historically, most evidence supporting emergency airway management strategies have been limited to small series, retrospective analyses and extrapolation from other settings (i.e. the operating room). Over the past year, several large, randomized clinical trials have offered new findings to inform emergency airway management techniques. One large, randomized clinical trial, found improved first attempt success rates with bougie facilitated intubation compared with traditional intubation. Two randomized clinical trials suggested better outcomes in adult out-of-hospital cardiac arrest (OHCA) with supraglottic airways (SGA) than intubation. A randomized clinical trial in OHCA patients could not identify outcome differences between endotracheal intubation (ETI) and bag-valve mask (BVM) ventilation but suggested higher rates of aspiration with BVM. These studies offer new findings to inform the practice of emergency airway management. Bougie use should be considered as a first-line approach in emergency intubation. SGA-based strategies should be considered as a first-line approach in the management of OHCA.