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Acta Anaesthesiol Scand. 2016 Aug;60(7):852-64. doi: 10.1111/aas.12746. Epub 2016 Jun 3.

Scandinavian SSAI clinical practice guideline on pre-hospital airway management.

Author information

1
The Norwegian Air Ambulance Foundation, Drøbak, Norway.
2
London's Air Ambulance, Barts Health Trust, London, UK.
3
Field of Pre-hospital Critical Care, University of Stavanger, Stavanger, Norway.
4
Department of Anaesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway.
5
Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland.
6
Centre for Pre-hospital Emergency Care, Kuopio University Hospital, Kuopio, Finland.
7
Department of Pre-hospital Care and Disaster Medicine, Region of Skåne, Lund, Sweden.
8
Pre-hospital Critical Care Service, Aarhus University Hospital, Aarhus, Denmark.
9
The Danish Air Ambulance, Aarhus, Denmark.
10
Norwegian Institute of Public Health, Oslo, Norway.
11
University College of Southeast Norway, Notodden, Norway.
12
Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
13
University of Oslo, Oslo, Norway.

Abstract

BACKGROUND:

The Scandinavian society of anaesthesiology and intensive care medicine task force on pre-hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines.

METHODS:

The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations.

RESULTS:

We recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non-trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device (SAD) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected indications or as a rescue device after failed endotracheal intubation (ETI) (good practice recommendation). We recommend that ETI should only be performed by advanced trained providers (strong recommendation, low QoE). We suggest that videolaryngoscopy is considered for ETI when direct laryngoscopy fails or is expected to be difficult (weak recommendation, low QoE). We suggest that advanced trained providers apply cricothyroidotomy in 'cannot intubate, cannot ventilate' situations (weak recommendation, low QoE).

CONCLUSION:

This guideline for pre-hospital airway management includes a combination of techniques applied in a stepwise fashion appropriate to patient clinical status and provider training.

PMID:
27255435
PMCID:
PMC5089575
DOI:
10.1111/aas.12746
[Indexed for MEDLINE]
Free PMC Article

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