Extraglottic devices for emergency airway management in adults
- Erik G Laurin, MD, FAAEM
Erik G Laurin, MD, FAAEM
- Professor of Emergency Medicine
- University of California, Davis, Medical Center
- Aaron E Bair, MD, MSc, FAAEM, FACEP
Aaron E Bair, MD, MSc, FAAEM, FACEP
- Professor of Emergency Medicine
- University of California, Davis
Extraglottic airway devices are used to establish an airway for oxygenation and ventilation without entering the trachea. They are important tools for airway management and are used frequently in the prehospital environment, emergency department, operating room, and other settings. They can be primary airway devices, such as during cardiopulmonary resuscitation, or rescue devices for failed airways.
This topic reviews the types of extraglottic devices (EGD) commonly found in emergency settings, how to place them and use them for intubation, and their appropriate role in emergency airway management. Other devices used for emergency airway management, approaches to emergency airway management in various clinical settings, and the use of EGD in the operating room are discussed separately. (See "Approach to the difficult airway in adults outside the operating room" and "The difficult pediatric airway" and "The failed airway in adults" and "Devices for difficult emergency airway management in adults" and "Supraglottic devices (including laryngeal mask airways) for airway management for anesthesia in adults".)
EXTRAGLOTTIC AIRWAY DEVICES
General indications and contraindications — Extraglottic devices (EGDs) provide an airway for oxygenation and ventilation without entering the trachea. They are important tools for emergency airway management and may be used as either primary or rescue devices, although they do not provide a definitive airway that protects the trachea from obstruction or aspiration.
Indications for placing an EGD include the need for oxygenation and ventilation. Contraindications include the following:
●Presence of a gag reflex (risk of vomiting and aspiration); may be used in patients with gag reflex who are paralyzed as part of rapid sequence intubation.
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- EXTRAGLOTTIC AIRWAY DEVICES
- General indications and contraindications
- Types of devices and their features
- Use in emergency settings
- SUPRAGLOTTIC AIRWAYS
- Laryngeal mask airways (LMA)
- - Types of LMAs
- - Standard LMA placement
- - LMA Fastrach (intubating LMA)
- Placement of LMA Fastrach
- Intubation through LMA Fastrach
- Removal of LMA Fastrach following successful intubation
- Other supraglottic airways
- Intubation using flexible endoscope
- RETROGLOTTIC AIRWAYS
- Laryngeal tubes
- King laryngeal tube (LT)
- Rusch EasyTube
- Intubating Laryngeal Tube Suction Disposable (iLTS-D)
- SUMMARY AND RECOMMENDATIONS