Managing and securing the bleeding upper airway: a narrative review

Area of Science:

• Anesthesiology
• Emergency Medicine
• Critical Care

Background:

• Airway bleeding is a critical challenge in emergency medicine.
• Impeded visibility from bleeding can render standard airway management techniques ineffective.
• Failure to manage airway bleeding contributes significantly to airway-related mortality.

Purpose of the Study:

• To review and identify effective techniques for managing severe upper airway bleeding.
• To provide strategies for establishing a definitive airway when traditional methods are compromised by bleeding.
• To guide clinicians in selecting appropriate airway management approaches based on bleeding severity and predicted success rates.

Main Methods:

• A comprehensive literature search of bibliographic databases, guidelines, and textbooks was performed.
• Search terms focused on airway management and severe bleeding scenarios.
• Narrative review methodology was employed to synthesize identified techniques and strategies.

Main Results:

• Several advanced techniques can establish a definitive airway despite severe bleeding and visual impairment.
• These include flexible scope-guided intubation through supraglottic devices, surgical airways (cricothyroidotomy/tracheotomy), and various guided intubation methods (retrograde, blind nasal, digital, light, ultrasound).
• A structured approach is proposed, considering bleeding source and predicted failure of direct laryngoscopy or front-of-neck access.

Conclusions:

• Advanced airway management techniques are crucial for patients with severe upper airway bleeding.
• An awake approach with specialized techniques is recommended when traditional methods are predicted to fail.
• Preparation for surgical airway rescue and rapid sequence induction are key components of the management strategy.