Confined space airway management: a narrative review

Area of Science:

• Emergency Medicine
• Prehospital Care
• Airway Management

Background:

• Airway management in prehospital and emergency settings is often complicated by environmental factors.
• Confined Space Airway Management (CSAM) involves scenarios with restricted physical space challenging conventional techniques.
• CSAM occurs in unpredictable environments like vehicle entrapments or controlled settings such as helicopters.

Purpose of the Study:

• To synthesize current knowledge, expert opinions, and evidence on Confined Space Airway Management (CSAM).
• To provide insights into the challenges and strategies for effective airway management in restricted environments.

Main Methods:

• This narrative review synthesizes existing literature and expert opinions on CSAM.
• Focuses on logistical and technical challenges, including limited access, restricted movement, and reduced visibility.
• Evaluates the role of supraglottic airways (SGA), tracheal intubation (TI), and emergency front of neck access (eFONA).

Main Results:

• Supraglottic airways (SGA) are recommended as a first-line approach in CSAM due to ease of insertion and high success rates.
• Tracheal intubation (TI) may require modified techniques; adjuncts depend on provider expertise and scenario.
• Emergency front of neck access (eFONA) shows high success rates in confined spaces; preparation is crucial in controlled settings.

Conclusions:

• CSAM necessitates a strategic combination of medical expertise, adaptive techniques, and logistical planning.
• Training, preparedness, and the use of supraglottic airway devices can mitigate challenges in high-stakes CSAM scenarios.
• Prioritizing patient extrication and oxygenation is essential in uncontrolled environments where definitive airway management may conflict with rescue efforts.