Unrecognized Failed Airway Management Using a Supraglottic Airway Device

Unrecognized Failed Airway Management Using a Supraglottic Airway Device: 911 Emergency Medical Services (EMS) systems utilize supraglottic devices for either primary advanced airway management, or for airway rescue following failed attempts at direct laryngoscopy endotracheal intubation. There is, however, limited data on objective confirmation of supraglottic airway placement in the prehospital environment. Furthermore, the ability of EMS field providers to recognize a misplaced airway is unknown.Article in Press

Unrecognized Failed Airway Management Using a Supraglottic Airway Device

Veer D. VithalaniCorrespondence information about the author Veer D. VithalaniEmail the author Veer D. Vithalani

, 

Sabrina VlkEmail the author Sabrina Vlk

, 

Steven Q. DavisEmail the author Steven Q. Davis

, 

Neal J. RichmondEmail the author Neal J. Richmond

Office of the Medical Director, Emergency Physicians Advisory Board, MedStar 911 Mobile Healthcare, 2900 Alta Mere Drive, Fort Worth, TX 76116, United States

DOI: http://ift.tt/2tVH9ce

Article Info

• Abstract

Abstract

Background

911 Emergency Medical Services (EMS) systems utilize supraglottic devices for either primary advanced airway management, or for airway rescue following failed attempts at direct laryngoscopy endotracheal intubation. There is, however, limited data on objective confirmation of supraglottic airway placement in the prehospital environment. Furthermore, the ability of EMS field providers to recognize a misplaced airway is unknown.

Methods

Retrospective review of patients who underwent airway management using the King LTS-D supraglottic airway in a large urban EMS system, between 3/1/15-9/30/2015. Subjective success was defined as documentation of successful airway placement by the EMS provider. Objective success was confirmed by review of waveform capnography, with the presence of a 4-phase waveform greater than 5 mmHg. Sensitivity and specificity of the field provider's assessment of success were then calculated.

Results

A total of 344 supraglottic airway attempts were reviewed. No patients met obvious death criteria. 269 attempts (85.1%) met criteria for both subjective and objective success. 19 attempts (5.6%) were recognized failures by the EMS provider. 47 (13.8%) airways were misplaced but unrecognized by the EMS provider. 4 attempts (1.2%) were correctly placed but misidentified as failures, leading to the unnecessary removal and replacement of the airway. Sensitivity of the provider's assessment was 98.5%; specificity was 28.7%.

Conclusion

The use of supraglottic airway devices results in unrecognized failed placement. Appropriate utilization and review of waveform capnography may remedy a potential blind-spot in patient safety, and systemic monitoring/feedback processes may therefore be used to prevent unrecognized misplaced airways.

from ! Medicine by Alexandros G. Sfakianakis via alwin on Inoreader http://ift.tt/2tVabce
via IFTTT