Unanticipated and Emergency Difficult Airway Management

What is the reported first attempt intubation success rate for difficult airways using stylets and tracheal tubes in an emergency department?

Which device showed equivocal findings for intubation success with difficult airways when compared to direct laryngoscopy?

What is the success rate of flexible bronchoscopy for intubation rescue after failed direct laryngoscopy?

What is recommended upon encountering an unanticipated difficult airway?

What should be limited to avoid potential injury and complications when managing unanticipated difficult airways?

What intervention should be ensured if an invasive approach to the airway is necessary?

Unanticipated and Emergency Difficult Airway Management

Unanticipated and emergency difficult airway management involves 7 key interventions: calling for help, optimizing oxygenation, using a cognitive aid, utilizing noninvasive airway management devices, employing combination techniques, performing invasive airway management interventions, and using ECMO.

Literature Findings

There is insufficient literature to evaluate patient outcomes associated with immediate access to airway management support equipment or calling for help.
The literature is also insufficient to evaluate difficult airway patient outcomes associated with the use of a visual aid, cognitive aid, or algorithm for unanticipated or emergency difficult airways.

Case Reports and Devices

Case reports have shown successful emergency ventilation via tube exchangers using expiratory ventilation assistance after multiple failed intubation attempts (Category B4-B evidence).
Devices for noninvasive airway management of patients with unanticipated or emergency difficult airways include:
- Rigid laryngoscopic blades of alternative designs and sizes
- Adjuncts (e.g., introducers, bougies, stylets, and alternative tracheal tubes)
- Videolaryngoscopes
- Flexible intubation scopes
- Supraglottic airway devices (supraglottic airways)
- Lighted or optical stylets
- Rigid bronchoscopes

Test your knowledge of airway management in unanticipated or emergency difficult airway situations. This quiz covers calling for help, optimizing oxygenation, using cognitive aids, noninvasive and invasive airway management techniques, and ECMO interventions.