Remember the Laryngeal Mask Airway When You Can’t Intubate!
As a hospitalist who also works in the ICU, I am often the first responder to respiratory emergencies. Frequently under these circumstances, you have a chaotic environment and a less than optimal environment to intubate a patient. The advice I give to my residents at this point is to first take a moment, compose yourself and calm your nerves.
The next thing to do is to try and move the patient to a location where you can optimally address their airway. If the patient is on the floor, lift them onto a bed where you can try to optimize patient positioning. Endotracheal intubation in these respiratory emergencies is extremely challenging for a number of reasons: the patient may have a full stomach increasing the chance of emesis, the patient will likely have poor oxygenation and ventilation, they may have hemodynamic instability, and you may not have all the equipment needed for a difficult airway (e.g., a Bougie or a Glidescope, etc). All of these challenges make an unsuccessful intubation more likely.
In these circumstances, you may be faced with the dreaded Can’t Intubate Can’t Ventilate scenario. Remember your laryngeal mask airway (or LMA) in this situation. The LMA is placed blindly and is very easy to insert to use as a rescue airway device. The LMA can be connected to a ventilator and used for up to 6 hours. In reality, it is used to stabilize a patient to allow you to call your back-up for a more definitive airway. It is a great rescue airway that you should turn to if you are unable to intubate a patient in 2-3 attempts. Remember that patients should not be transported to another facility with a LMA.
Joseph Esherick, MD, FAAFP
Hospital Procedures Consultants