Alison Leung, MD
Assistant Professor
University of Florida
Gainesville, Florida, United States
Disclosure information not submitted.
Jason Jones, MD
Assistant Professor
University of Florida
Gainesville, Florida, United States
Disclosure information not submitted.
Muhammad Abdul Baker Chowdhury, MPH, MPS, MS
Biostatistician
University of Florida, United States
Disclosure information not submitted.
Charles Hwang, MD
Assistant Professor
University of Florida, United States
Disclosure information not submitted.
Desmond Fitzpatrick, MD
Assistant Professor
University of Florida, United States
Disclosure information not submitted.
David Meurer, MD
Assistant Professor
University of Florida, United States
Disclosure information not submitted.
Alicia Buck, MD
Assistant Professor
University of Florida, United States
Disclosure information not submitted.
Torben Becker, MD, PhD
Chief, Division of Critical Care Medicine
Shands Hospital - University of Florida
Gainesville, Florida
Disclosure information not submitted.
Title: Medication-Facilitated Advanced Airway Management With First-Line Use of a Supraglottic Device
Introduction: Airway management is a controversial topic in modern emergency medical services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SAD) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics.
Methods: In 2019, Alachua County Fire Rescue (ACFR) introduced a novel protocol for advanced airway management emphasizing first-line use of a second-generation SAD (i-gel) for patients requiring medication-facilitated airway management (referred to as 'rapid sequence airway' (RSA) protocol). One year after implementation, we performed a quality assurance review of care provided under the RSA protocol. Records were obtained from the agency’s electronic medical record, searching for the use of the RSA protocol, advanced airway devices, or either ketamine or rocuronium. If available, hospital follow-up data regarding patient condition and ED airway exchange were obtained. Chi square analysis was performed to evaluate the relationship between the number of airway attempts and use of paralytic or sedative and rates of hypoxia and hypotension.
Results: During the first year, 33 advanced airway attempts were made under the protocol by 23 paramedics. Overall, compliance with the airway device sequence as specified in the protocol was 73%. When ETI was non-compliantly used as first-line airway device, the first-pass success rate was 44% compared to 87% with adherence to first-line SAD use. There was no statistically significant relationship between the number of airway attempts and sedative use, paralytic use, or post-RSA hypoxia or hypotension. All prehospital SAD were exchanged in the ED in a delayed fashion and almost exclusively per physician preference alone. In no case was the SAD exchanged for suspected dislodgement evidenced by lack of capnography.
Conclusion: First-line use of a SAD was associated with a high-first pass attempt success rate in a real-life cohort of prehospital advanced airway encounters. No SAD required emergent exchange upon hospital arrival.