Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document

Abstract

Airway management is a critical component of resuscitation but also carries the potential to disrupt perfusion, oxygenation, and ventilation as a consequence of airway insertion efforts, the use of medications, and the conversion to positive-pressure ventilation.

NAEMSP recommends:

• Airway management should be approached as an organized system of care, incorporating principles of teamwork and operational awareness.

• EMS clinicians should prevent or correct hypoxemia and hypotension prior to advanced airway insertion attempts.

• Continuous physiological monitoring must be used during airway management to guide the timing of, limit the duration of, and inform decision making during advanced airway insertion attempts.

• Initial and ongoing confirmation of advanced airway placement must be performed using waveform capnography. Airway devices must be secured using a reliable method.

• Perfusion, oxygenation, and ventilation should be optimized before, during, and after advanced airway insertion.

• To mitigate aspiration after advanced airway insertion, EMS clinicians should consider placing a patient in a semi-upright position.

• When appropriate, patients undergoing advanced airway placement should receive suitable pharmacologic anxiolysis, amnesia, and analgesia. In select cases, the use of neuromuscular blocking agents may be appropriate.

Key words:

• airway management
• guidelines
• physiology
• preoxygenation
• resuscitation