Pre‐hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine

Abstract

This article is intended as a generic guide to evidence- based airway management for all categories of pre-hospital personnel. It is based on a review of relevant literature but the majority of the studies have not been performed under realistic, pre-hospital conditions and the recommen- dations are therefore based on a low level of evidence (D). The advice given depends on the qualifications of the personnel available in a given emergency medical service (EMS). Anaesthetic training and routine in anaesthesia and neuromuscular blockade is necessary for the use of most techniques in the treatment of patients with airway reflexes. For anaesthesiologists, the Task Force commis- sioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intu- bation (ETI) following rapid sequence induction when securing the pre-hospital airway, although repeated un- successful intubation attempts should be avoided inde- pendent of formal qualifications. Other physicians, as well as paramedics and other EMS personnel, are recom- mended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients. When performing advanced cardiopul- monary resuscitation, we recommend that non-anaesthe- siologists primarily use a supraglottic airway device. A supraglottic device such as the laryngeal tube or the intubation laryngeal mask should also be available as a backup device for anaesthesiologists in failed ETI.