Supraglottic Airway

Supraglottic airway devices have emerged as valuable tools for airway management, particularly in cardiac arrest. When compared to endotracheal intubation, in which some studies have found high rates of misplacement, skill degradation and prolonged pauses of chest compressions during cardiac arrest, supraglottic airway devices are an attractive alternative.

• Are placed blindly.

• Require less training time.

• Can be placed in less time.

• Are easier to place during chest compressions.

A number of supraglottic airway devices are available, including:

• Laryngeal Mask Airway.

• Combitube.

• King Airway.

• air-Q.

• I-Gel (which can be placed blindly into the esophagus or hypopharynx. Ventilation is delivered through a port positioned above the glottic opening, and inflated cuffs or gel isolate the glottic opening to facilitate ventilation and protect the lower airway from aspiration.).

Supraglottic airways are not without complications. They must be inserted to the correct depth for the ventilation port to be over the glottic opening. A recent study shows a high rate of unrecognized misplacement of one supraglottic airway device, which is just as devastating as a misplaced endotracheal tube [1].

Other studies of various devices have described cases of inadequate ventilation, inadequate protection from aspiration, and an inability to detect lung sounds after placement.

Supraglottic airway devices are ineffective for patients with upper airway edema, such as from burns or anaphylaxis. Balloon over inflation can also cause upper airway trauma and compromise circulation through blood vessels in the neck.