Extraglottic Airway Device Misplacement: A Novel Classification System and Findings in Postmortem Computed Tomography

Area of Science:

• Emergency Medicine
• Anesthesiology
• Forensic Pathology

Background:

• Extraglottic airway devices are critical in emergency airway management.
• Literature indicates a significant rate of extraglottic airway device misplacement.
• Accurate device placement is crucial for patient outcomes.

Purpose of the Study:

• To develop a novel classification system for extraglottic airway device misplacement.
• To determine the frequency of extraglottic airway device misplacement in decedents.
• To describe associated complications using postmortem CT imaging.

Main Methods:

• Retrospective analysis of decedents with an in situ extraglottic airway device.
• Development of a 6-component classification system for device misplacement.
• Application of the classification system to postmortem CT scans of 341 decedents.

Main Results:

• Extraglottic airway devices were found to be misplaced in 49 cases (14.4%).
• Severe injuries associated with misplacement occurred in 1.5% of cases.
• Device misplacement involved depth, size, rotation, kinking, blockage, and injury.

Conclusions:

• A novel classification system for extraglottic airway device misplacement was successfully created.
• Over 14% of analyzed extraglottic airway devices demonstrated misplacement.
• Quality improvement initiatives should incorporate this classification system and CT review for airway device placement.