Prehospital Supraglottic Airways: An NAEMSP Position Statement and Resource Document

Lyng, John; Baldino, Kimberly T.; Braude, Darren; Fritz, Christie; March, Juan A.; Peterson, Timothy D.; Yee, Allen

doi:10.1080/10903127.2021.1983680

Cited by 7 publications

(3 citation statements)

References 101 publications

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“…Non-degreed paramedics are now licensed to insert supraglottic airway (SGA) devices as a primary means of securing the airway, while degreed paramedics often use SGAs as a rescue device in case of failed intubation. In other settings, SGAs have been shown to be safe and effective means for securing the airway and achieving oxygenation and ventilation in the prehospital setting [ 44 ]. This is especially true in cardiac arrest [ 45 ], a major indication for ETI in this study.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially true in cardiac arrest [ 45 ], a major indication for ETI in this study. However, their role in trauma is less clear with limited data [ 44 ]. There are currently no studies on the use of SGA as primary airway device from the South African setting and this should be considered in future however, its use as primary device shows some promise.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

et al. 2022

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Introduction Prehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success. Methods This study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS. Results A total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS. Conclusion This is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

et al. 2022

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“…Despite these advantages, SGA devices also present significant limitations compared to ETI. Indeed, these devices do not provide the same level of protection from pulmonary aspiration and can fail in some situations [10][11][12]. Moreover, even though leak pressure is usually adequate to take care of patients undergoing elective anesthesia [10], the airtightness of SGA devices might be compromised in the prehospital setting, particularly when airway resistance or pulmonary compliance are altered [13].…”

Section: Rationale For An Intermediate Airway Management Categorymentioning

confidence: 99%

The Importance of Acknowledging an Intermediate Category of Airway Management Devices in the Prehospital Setting

et al. 2022

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Prehospital airway devices as often classified as either basic or advanced, with this latter category including both supraglottic airway (SGA) devices and instruments designed to perform endotracheal intubation (ETI). Therefore, many authors analyze the impact of SGA and ETI devices jointly. There are however fundamental differences between these instruments. Indeed, adequate airway protection can only be achieved through ETI, and SGA devices all have relatively low leak pressures which might compromise both oxygenation and ventilation when lung compliance is decreased. In addition, there is increasing evidence that SGA devices reduce carotid blood flow in case of cardiac arrest. Nevertheless, SGA devices might be particularly useful in the prehospital setting where many providers are not experienced enough to safely perform ETI. Compared to basic airway management (bag-valve-mask) devices, SGA devices enable better oxygenation, decrease the odds of aspiration, and allow for more reliable capnometric measurement by virtue of their enhanced airtightness. For all these reasons, we strongly believe that SGA devices should be categorized as “intermediate airway management devices” and be systematically analyzed separately from devices designed to perform ETI.

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To Tube or Not to Tube ... That Continues to Be the Question

DeBoer,

Hoffman,

DeBoer

et al. 2023

Air Medical Journal

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Prehospital Supraglottic Airways: An NAEMSP Position Statement and Resource Document

Cited by 7 publications

References 101 publications

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

The Importance of Acknowledging an Intermediate Category of Airway Management Devices in the Prehospital Setting

To Tube or Not to Tube ... That Continues to Be the Question

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