Pediatric Airway Management: Supraglottic Airways

This is an excerpt from a continuing education article on pediatric airway management that appeared in the January 2012 issue of EMS World Magazine. To read the entire article, click here.

Many EMS systems, both BLS and ALS, have begun using supraglottic airways in managing adult patients. A smaller number have begun using them to manage pediatric airways^1,2 as an advanced adjunct in lieu of or as an alternative to ET intubation, or as a backup airway if ET intubation is unsuccessful.³

SGAs are placed blindly and are fast and easy to use, with insertion times as fast as five seconds.⁴ SGAs can be placed with CPR in progress, minimizing interruption of compressions, which makes them an ideal airway choice for first responders and BLS services that do not perform ET intubation.⁵

SGA is a broad term describing airway devices that may or may not have inflatable cuffs. If the SGA is cuffed, one cuff is typically inflated in the posterior oral pharynx, and often a second cuff in the upper esophagus, though this varies with manufacture and type.⁶ Some SGAs now use innovative materials that do not require cuffs and allow the airway to mold and seal around the device. SGAs come in many shapes and sizes from neonate to adult and may be reusable or disposable.

Most SGAs decrease the potential for aspiration, but do not completely eliminate the risk. By placing a gastric tube with or following placement of an SGA, the risk of aspiration can be further reduced.⁷ Once the SGA has been placed, assess for the presence of bilateral lung sounds and the absence of gastric sounds to confirm correct placement. Secure the SGA with tape or a commercial tube restraint.

References

1. Guyette FX, Wang H, Cole JS. King airway use by air medical providers. Prehosp Care 11(4): 473–76, 2007.

2. Frascone RJ, Wewerka SS, Griffith KR, Salzman JG. Use of the King LTS-D during medication-assisted airway management. Prehosp Care 13(4): 541–545, 2009.

3. Schalk R, et al. Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tube. Resusc 81(3): 323–26, 2010.

4. Kleinman M, et al. Pediatric basic and advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Pediatrics 126(5): 1,261–1,318, 2010.

5. Bamgbade OA, Macnab WR, Khalaf WM. Evaluation of the i-gel airway in 300 patients. Eur Anaesthesiol 25(10): 865–6, 2008.

6. Bein B, Scholz J. Supraglottic airway devices. Best Prac & Research in Clin Anaesth 19(4): 581–93, 2005.

7. Bercker S, Schmidbauer W, Volk T, et al. A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure. Anesth & Analg 106(2): 445–8, 2008.

Scott Tomek, MA, EMT-P, has been a paramedic for 25 years, 23 with Lakeview Hospital EMS in Stillwater, MN. He is a faculty member with the Century College paramedic program, and a curriculum development specialist.