The following is a summary of “Extraglottic device use is rare during emergency airway management: A National Emergency Airway Registry (NEAR) study,” published in the October 2023 issue of Emergency Medicine by April, et al.

Effective airway management is crucial in emergency department (ED) settings, focusing predominantly on endotracheal intubation in existing literature. However, more information about using extraglottic devices (EGDs) in EDs was needed. For a study, researchers sought to outline the frequency, success rates, and complications associated with EGD utilization among ED patients.

The National Emergency Airway Registry (NEAR) was a prospective, multi-center observational registry capturing data on airway management in ED patients. A secondary analysis was conducted, focusing on encounters where EGD placement occurred. Descriptive statistics were employed to characterize these encounters.

Out of 19,071 patients undergoing intubation attempts, only 56 (0.3%) underwent EGD placement. Among 25 participating sites, 13 reported no instances of EGD placement, and the median number of EGDs per site was 2 (interquartile range 1–2.5, range 1–31). About 54% of patients had hypotension or hypoxia before airway management initiation. Difficult airway anticipation was reported in 55%, with 93% exhibiting at least one difficult airway characteristic. Placement of a laryngeal mask airway (LMA®) Fastrach™ occurred in 41 encounters, with subsequent successful intubation through the EGD in 33 cases. Standard LMA® devices were used in 10 encounters. Around 34 EGDs (61%) were placed during the initial intubation attempt. Adverse events were reported in 30% of cases, with 25% experiencing hypoxemia. No fatalities resulted from failed airways.

EGD usage was infrequent in the multi-center ED registry, predominantly in patients with difficult airway characteristics. Despite the rarity of use, favorable outcomes were observed, suggesting that clinicians should consider EGDs for patients with suspected difficult airways in emergencies.

Source: sciencedirect.com/science/article/abs/pii/S0735675723003777