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Updates in emergency airway management

Carlson, Jestin N.a; Wang, Henry E.b

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 525–530
doi: 10.1097/MCC.0000000000000552
EMERGENCIES IN CRITICAL CARE: Edited by Wesley H. Self

Purpose of review 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.

Recent findings 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.

Summary 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.

aDepartment of Emergency Medicine, Allegheny Health Network, Erie, Pennsylvania

bDepartment of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA

Correspondence to Jestin N. Carlson, MD, MSc, Department of Emergency Medicine, Allegheny Health Network, 232 West 25th St, Erie, PA 16544, USA. E-mail: jestin.carlson@ahn.org

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