All About Supraglottic Airway… pt. 2

This week I am highlighting two airway discussion points which have recently come to my attention: cuffed vs. non-cuffed endotracheal tubes (ETTs) in pediatric patients and the possible, negative side effects of supraglottic airways.

See my first post on cuffed vs. non-cuffed endotracheal tubes: Part 1

Supraglottic Airways: Help or Harm?

Health Care Providers (HCPs), working in multi-disciplinary, team oriented environments, are able to achieve rapid and early airway management without interrupting resuscitation efforts. However, the role of ETTs has been de-emphasized during cardiac arrest management and HCPs are encouraged to use alternate airway devices, such as supraglottic airways.

Supraglottic airways minimize interruptions in compressions and as a result, maximal blood flow to the brain. Or, so we thought…

A recent swine study shows evidence supraglottic devices may decrease cerebral blood flow in low output states. See the article below.

http://emcrit.org/wee/extraglottic-airways-harmful-cardiac-arrest/

 Supraglottic Airway

In the ACLS courses I instruct at Iridia, I have been strongly encouraging the use of supraglottic airway devices.  Mainly because King Tubes or laryngeal mask airways can be inserted without stopping chest compressions and this allows for more blood to the brain. But, if these airway devices impede blood flow to the brain, should we be using them at all?

What is the future of airway management during cardiac arrests? Will newer, high-tech devices make it to market or will airway management go back to a head-tilt, chin-lift with oxygen from a simple mask?

I’d love to hear your thoughts and opinions. Let me know what you think about these discussion points.

All About Airway – Endotracheal Tubes

This week I want to highlight two airway discussion points which have recently come to my attention: cuffed vs. non-cuffed endotracheal tubes (ETTs) in pediatric patients and the possible, negative side effects of supraglottic airways.

Endotracheal Tubes: Cuffed vs non-cuffed

In June, 2012, a memo was released by the BC Children’s Trauma Program advising the use of cuffed ETTs over non-cuffed. I copied the wording below, click the link to see the memo.

“BC Children’s Hospital’s Trauma Program and Pediatric Intensive Care Physicians are requesting that all pediatric trauma and burn patients who require intubation at another facility, be intubated with a CUFFED endotracheal tube. This is currently the standard in the BCCH Emergency Room, Pediatric ICU, and Operating Room.”
 endotracheal tubes
 
“Uncuffed endotracheal tubes run the risk of large air leaks which make effective ventilation difficult, and may require reintubation with a cuffed tube. The risk of reintubating these patients can be of particular concern in the burn population.”

What does this mean to me? I understand how critical airway management and ventilation is to the unstable pediatric patient. The memo specifies pediatric burn and trauma patients. I wonder how this recommendation applies to a primary respiratory or cardiac arrest pediatric patient?

I look forward to your thoughts and discussions.

Stay tuned for tomorrow’s post on supraglottic airways.