EMS World Expo 2018

In dealing with the critically ill, some will require an advanced airway. Many of these patients will be challenging to oxygenate and ventilate and also have underlying pulmonary pathology and a physiologic shunt. The ideal approach to pre-oxygenation and denitrogenation has been controversial. Using standard equipment in parallel to optimize our patients’ hemodynamics has also been controversial (e.g. nasal cannula + BVM with separate oxygen sources as part of pre-oxygenation protocol) and not universally accepted. In addition, apneic oxygenation with a nasal cannula at high flow rates has not been universally adopted despite advocacy by emergency airway experts.  This year, the ENDAO trial (EmergeNcy Department Use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial) showed no difference in lowest mean oxygen saturation between the two groups. To quote the authors, “application of AO during RSI did not prevent desaturation of patients in this study.” Despite this, many continue to recommend the use of AO for emergent airways.  In this lecture we will review the protocols, various application techniques, study the objective evidence behind these practices and discuss best practices for our patients to optimize the airway prior to laryngoscopy.