Emergency airway management: Best practices and new innovations for critical care

Abstract

Background: Airway management is a crucial component of resuscitating critically ill patients, especially in emergency and out-of-hospital cardiac arrest (OHCA) scenarios. Traditional methods like endotracheal intubation (ETI) face challenges related to skill requirements, resource limitations, and interruptions to CPR. Recent innovations like supraglottic airways (SGA) and the bougie have gained attention as potential alternatives. Aim: This article aims to review best practices in emergency airway management, particularly focusing on the comparative effectiveness of ETI, SGAs, and other emerging techniques. Methods: This review summarizes findings from randomized clinical trials, including the Bougie Use in Emergency Airway Management (BEAM) trial and other studies comparing ETI with SGAs and bag-valve-mask (BVM) ventilation in OHCA settings. It evaluates first-attempt success rates, patient survival outcomes, and complications. Results: The BEAM trial found a higher first-attempt success rate for bougie-assisted intubation (98%) compared to conventional methods (87%). Other studies revealed similar neurological outcomes between BVM and ETI, while SGAs showed a survival advantage over ETI in prehospital settings. However, higher ventilation failure rates were noted with BVM. Conclusion: SGAs and bougie devices offer promising alternatives to ETI, particularly in resource-constrained or prehospital environments. BVM remains a viable option but presents complications.