Complications associated with supraglottic airway use in an urban ambulance service: a case series

Abstract

Background Current resuscitation guidelines deemphasise the role of endotracheal intubation (ETI) in cardiac arrest. Although supraglottic airways (SGA) are increasingly used in the management of prehosptial cardiac arrest, there is limited data relating to adverse events in practice. Methods Cases reported to an ambulance service medical directorate involving adverse events associated with SGA use in cardiac arrest were logged from April 2014–October 2015. Prehospital clinical notes were reviewed to determine patient demographics, details of adverse events, clinical course and patient disposition. Results A total of 6 cases were reported. All patients were male and aged between 35–83 years. The majority of cases (n=4) were associated with a history of choking and the supraglottic device was removed to facilitate ETI due to poor ventilation. In all these cases, laryngoscopy revealed the presence of food obscuring the glottis which was removed under direct vision. None of these patients presented in a shockable rhythm and 3 experienced sustained return of spontaneous circulation. In another case, insertion of the supraglottic airway resulted in traumatic avulsion of teeth necessitating direct removal under laryngoscopy. This patient presented in ventricular fibrillation following chest pain and achieved ROSC at the scene. The final case involved a 35 years male with an extensive history of deliberate self-harm who received ventilation via SGA throughout the resuscitation attempt. A plastic bag was found compacted into the airway at post mortem. Conclusions The majority of adverse events associated with SGA use in cardiac arrest related to airway obstruction following choking. ROSC in a number of these patients suggests this may have been a reversible cause of cardiac arrest. Future guidelines should emphasise the need for laryngoscopy to exclude foreign body airway obstruction prior to SGA insertion in appropriate cases. https://emj.bmj.com/content/emermed/33/9/e8.2.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2016-206139.27