Unrecognized failed airway management using a supraglottic airway device

Area of Science:

• Emergency Medicine
• Critical Care
• Airway Management

Background:

• Emergency Medical Services (EMS) utilize supraglottic airway devices for advanced airway management and rescue.
• Limited data exists on objective confirmation of supraglottic airway placement in prehospital settings.
• The ability of EMS providers to recognize misplaced airways is largely unknown.

Purpose of the Study:

• To evaluate the accuracy of EMS provider assessments of supraglottic airway placement.
• To determine the incidence of unrecognized misplaced supraglottic airways in a prehospital setting.
• To assess the utility of waveform capnography for objective confirmation of airway placement.

Main Methods:

• Retrospective review of 344 King LTS-D supraglottic airway attempts in an urban EMS system.
• Subjective success defined by provider documentation; objective success by waveform capnography.
• Calculated sensitivity and specificity of provider assessment for airway placement.

Main Results:

• 85.1% of airways were both subjectively and objectively successful.
• 13.8% of airways were misplaced but unrecognized by EMS providers.
• Provider assessment sensitivity was 98.5%, but specificity was only 28.7%.

Conclusions:

• Unrecognized failed placement of supraglottic airways occurs in prehospital EMS.
• Waveform capnography is crucial for objective confirmation and improving patient safety.
• Systemic monitoring and feedback processes can help prevent unrecognized misplaced airways.