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Management of the airway in multitrauma

Dupanovic, Mirsad; Fox, Heather; Kovac, Anthony

Current Opinion in Anesthesiology: April 2010 - Volume 23 - Issue 2 - p 276–282
doi: 10.1097/ACO.0b013e3283360b4f
Trauma and transfusion: Edited by Peter Papadakos

Purpose of review The primary purpose of this article is to highlight the latest airway research in multitrauma.

Recent findings Management of the airway in multitrauma patients is a critical resuscitation task. Prehospital airway management is difficult with a high risk of failure, complications, or both. In-hospital performed conventional oral intubation with manual in-line stabilization, cricoid pressure, and a backup plan for a surgical airway is still the most efficient and effective approach for early airway control in multitrauma patients. Selective utilization of airway maintenance, instead of ultimate airway control in the field, has been suggested as a primary prehospital strategy. Properties of videolaryngoscopes complement standard laryngoscopes. When compared with a Macintosh laryngoscope, the Airtraq and Airwayscope diminish cervical spine motion during elective orotracheal intubation. Penetrating neck injuries are the most frequent indication for awake intubation, whereas patients with maxillofacial injuries have the highest rate of initial surgical airway.

Summary Risks and benefits of ultimate prehospital airway control is a controversial topic. Utilization of videolaryngoscopes in multitrauma remains open for research. Standardization of training requirements, equipment, and development of prehospital and in-hospital airway algorithms are needed to improve outcomes. Rational utilization of available airway devices, development of new devices, or both may help to promote this goal.

Department of Anesthesiology, Kansas University Medical Center, Kansas City, Kansas, USA

Correspondence to Mirsad Dupanovic, MD, Assistant Professor of Anesthesiology, Kansas University Medical Center, Mail Stop 1034, 3901 Rainbow Blvd., Kansas City, KS 66160, USA Tel: +1 913 588 5053; fax: +1 913 588 3365; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.