Emergency airway management is being revolutionized. Think about it…those of us who are in training now are being exposed to some very different core skills. The big culprit is the recent advent of video laryngoscopy – not much argument there.
With that said, I will argue that almost as significant as the advent of video laryngoscopy from a general “airway management revolution” perspective is the philosophical change of many pre-hospital providers in that it is becoming the norm for extra-glottic devices to be placed primarily, or at least considerably more often than in the past.
It is likely that the rate of field placement of extra-glottic devices will become more common. Thus, we will probably see many more patients present to the ED in whom EMS has placed an extra-glottic. As we recognize the power of extra-glottic devices, I think that even the most advanced airway managers will use extra-glottic devices with more frequency to facilitate rescue oxygenation and ventilation.
This begs the obvious question: should we remove these devices after they are in and working? One might argue that eventual placement of an endotracheal tube is required in almost all cases. But hang on, we all have anecdotes of airways becoming edematous after an extra-glottic has been in place – so what now?
It is unrealistic to think that people who need their airways secured long term are going to get away without an endotracheal tube. If you think differently, please speak up.
So let’s do the next best thing. Let’s figure out a way to leave the extra-glottic device in, ventilate and oxygenate through it, and intubate through it without ever (practically) exposing the patient to an apneic period.
Without further ado, please check out this video slide-set we put together that is our answer to that conundrum. We propose what we believe is a simple way to maintain ventilation and oxygenation in the patient in whom an EGD has been placed, by any provider in any location.
Note: only 2nd generation “LMA style” airways will work with what we have come up with (the blind intubating I-LMA actually is harder to use our FOI technique through as compared to a 2nd gen LMA).
Let us know what you think…
- Walls RM, Murphy MF. Manual of Emergency Airway Management. Fourth Edition. Chapters 10 and 11.