Prehospital management of the traumatized airway

Prehospital airway obstruction is common following traumatic injury. Airway management of these patients is difficult in the prehospital setting, particularly because those providing care are often not trained in the skills necessary for endotracheal intubation. As a result, a number of alternative devices are available for airway maintenance. Nevertheless, endotracheal intubation remains the gold standard in airway management. Although it provides the optimum airway and protects the airway from aspiration, its successful insertion requires regular training. Incorrect placement carries considerable risk. The laryngeal mask airway may be a suitable alternative for many situations and appears to be the best alternative to endotracheal intubation. Training in its use is straightforward and it is relatively easy to insert. Risks of aspiration appear small. The pharyngotracheal lumen airway and Combitube are both more difficult to use than the laryngeal mask airway and risk inflating the stomach if the devices are incorrectly used. Cricothyroidotomy is associated with serious complications but is only used where there is no other option. As with other techniques, it requires regular training in its use.