Emergency airway management in the prone position: an observational mannequin-based simulation study

Area of Science:

• Anesthesiology
• Airway Management
• Emergency Medicine

Background:

• Accidental extubation during prone positioning is a critical emergency requiring immediate airway establishment.
• Limited evidence exists on optimal airway rescue techniques for this specific scenario.
• This study addresses the need for evidence-based guidelines in managing this high-risk complication.

Purpose of the Study:

• To compare the effectiveness of three airway rescue techniques: supraglottic airway device (SAD), video laryngoscopy (CMAC), and fiber-optic bronchoscopy (FOB).
• To determine the most efficient and successful method for managing accidental extubation in a simulated prone position.
• To provide data to guide clinical practice in emergency airway management during prone positioning.

Main Methods:

• A simulation-based study involving 11 anesthesiologists and 12 anesthesia fellows.
• Participants managed simulated accidental extubations in a prone position using a mannequin.
• Key metrics included time to definitive airway management and success rates for each technique (SAD, CMAC, FOB).

Main Results:

• The supraglottic airway device (SAD) achieved a 100% success rate with a mean insertion time of 18.1 seconds.
• Fiber-optic bronchoscopy (FOB) had a success rate of 91.3% and a mean insertion time of 57.3 seconds.
• Video laryngoscopy (CMAC) showed a success rate of 69.6% and the longest mean insertion time of 78.3 seconds; all comparisons were statistically significant (p < 0.001).

Conclusions:

• The supraglottic airway device (SAD I-gel) is recommended as the primary technique for immediate airway rescue following accidental extubation in the prone position due to its high success rate and speed.
• Fiber-optic bronchoscopy (FOB) is a more successful alternative than video laryngoscopy (CMAC) for securing a definitive airway in this context.
• These findings support the use of SAD for temporary airway establishment and FOB for definitive airway management in simulated prone extubation emergencies.