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Alternative Rescue Airway Management

Date Last Search Run: Nov 12, 2019
Table last updated: Dec 18, 2019
Data last added: Apr 04, 2020


Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)
3 (weak evidence exists)  


Interventions

Bougie-assisted Cricothyrotomy
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Successful intubation Process PH-Paramedic Braude D., Webb H., Stafford J., et al. The bougie-aided cricothyrotomy. Air Med J 2009; 28(4):191-4. Medline
III Supportive (Green) Successful intubation Patient PH-Paramedic Morris A., Lockey D., Coats T. Fat necks: Modification of a standard surgical airway protocol in the pre-hospital environmental. Resuscitation 1997; 35(3):253-4. Medline
X Not Yet Graded (White) - Dorsam JM., Cornelius SR., McLean JB., Zarow GJ., Walchak AC., Conley SP., et al. Randomized Comparative Assessment of Three Surgical Cricothyrotomy Devices on Airway Mannequins. Prehospital emergency care 2019; 23(3):411-9. Medline

BVM
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Favorable neurological outcome at 28 days Patient Jabre P., Penaloza A., Pinero D. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. JAMA. 2018; 319(8):779-787 Medline
I Neutral (Yellow) Ease and speed of placement Process OR Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 1995; 42(11):1017-23. Medline
I Neutral (Yellow) Ease of handling and efficacy of ventilation Process Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine; 25(1):104. Medline
I Neutral (Yellow) Success of airway management Patient PH-Paramedic Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
II Supportive (Green) Rate of oxygen desaturation/Hypoxia Process PH-Paramedic Davis DP., Hwang JQ., Dunford JV. Rate of decline in O2 saturation at various pulse oximetry values with prehospital RSI. PEC 2008; 12:46-51. Medline
II Supportive (Green) Long-term Survival Patient PH-Paramedic Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
II Supportive (Green) Survival to discharge Process PH-Paramedic Hanif MA., Kaji AH., Niemann JT. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Acad Emerg Med 2010; 17(9):926-31. Medline
II Supportive (Green) Favourable neurological outcome 1 month Patient PH-Paramedic Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
II Supportive (Green) Multiple measures of chest compression interruptions Process Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
II Supportive (Green) Survival to discharge Patient Jeong S., Ahn KO., Shin SD. The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis. Am J Emerg Med 2016; 34(11):2101-2106. Medline
II Supportive (Green) Arterial pH Patient PH-Paramedic SOS-KANTO study group. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 2009; 73(3):490-496. Medline
II Supportive (Green) 30-day survival Patient Sulzgruber P., Datler P., Sterz F., Poppe M., Lobmeyr E., Keferböck M., et al. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis. Eur Heart J Acute Cardiovasc Care 2018; 7(5):423-431. Medline
II Neutral (Yellow) Neurologically intact survival to hospital discharge Patient PH-Paramedic Bobrow BJ., Ewy GA., Clark L., et al. Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Ann Emerg Med 2009; 54(5):656-62. Medline
II Neutral (Yellow) Ventilation efficacy Process OR Dorges V., Ocker H., Hagelberg S., Wenzel V., Idris AH., Schmucker P. Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag-valve-mask ventilation. Resuscitation 2000; 44(1):37-41. Medline
II Neutral (Yellow) Chest compression Fraction Process PH-Paramedic Maignan M., Koch FX., Kraemer M., et al. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. Medline
III Supportive (Green) Minute volume delivery Process SIM Lim JS., Cho YC., Kwon OY., Chung SP., Yu K., Kim SW. Precise minute ventilation delivery using a bag-valve mask and audible feedback. Am J Emerg Med 2012; 30(7):1068-71. Medline
III Supportive (Green) Mean tidal volume delivery. Process Reed P., Zobrist B., Casmaer M., Schauer SG., Kester N., April MD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med 2017; 1-6. Medline
III Neutral (Yellow) Success and efficacy of ventilation Process SIM Fischer H., Hochbrugger E., Fast A., Hager H., Steinlechner B., Koinig H., et al. Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation 2011; 82(3):326-31. Medline
III Neutral (Yellow) Tidal volume Patient SIM Johannigman JA., Branson RD., Davis K Jr., Hurst JM. Techniques of emergency ventilation: A model to evaluate tidal volume, airway pressure, and gastric insufflation. J Trauma 1991; 31(1):93-8. Medline
III Neutral (Yellow) Ventilation performance Process SIM Lee HY., Jeung KW., Lee BK., et al. The performances of standard and ResMed masks during bag-valve-mask ventilation. Prehosp Emerg Care 2013; 17(2):235-40. Medline
III Opposes (Red) Achievement of adequate tidal volumes Process Siegler J., Kroll M., Wojcik S., Moy HP. Can EMS Providers Provide Appropriate Tidal Volumes in a Simulated Adult-sized Patient with a Pediatric-sized Bag-Valve-Mask? Prehospital Emergency Care 2017; 21(1):74-78. Medline
X Not Yet Graded (White) - Costello JT., Allen PB., Levesque R. A Comparison of Ventilation Rates Between a Standard Bag-Valve-Mask and a New Design in a Prehospital Setting During Training Simulations. Journal of special operations medicine 2017; 17(3):59-63. Medline
X Not Yet Graded (White) - Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine 2017; 25(1):104. Medline
X Not Yet Graded (White) - Wang CH, Lee AF, Chang WT, et al. Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials [published online ahead of print, 2020 Jan 23]. Ann Emerg Med. 2020;S0196-0644(19)31434-9. doi:10.1016/j.annemergmed.2019.12.003 Medline

Combitube (with AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
III Opposes (Red) Speed of insertion Process Sanfilippo F., Chiarenza F., Maybauer DM., Maybauer MO. The Easytube for airway management: a systematic review of clinical and simulation studies. J Clin Anesth 2016; 31:215-22. Medline

Combitube (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Time to insertion Process OR Gaitini LA., Yanovsky B., Somri M., Tome R., Mora PC., Frass M., et al. Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation. J Clin Anesth 2011; 23(6):475-81. Medline
I Neutral (Yellow) Success of airway management Patient PH-Paramedic Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
II Supportive (Green) One month survival with favorable neurological outcome Patient PH-Paramedic Kajino K., Iwami T., Kitamura T., et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011; 15(5):R236. Medline
II Supportive (Green) Adequate ventilation Process OR Wafai Y., Salem MR., Baraka A., Joseph NJ., Czinn EA., Paulissian R. Effectiveness of the self-inflating bulb for verification of proper placement of the Esophageal Tracheal Combitube. Anesth Analg 1995; 80(1):122-126. Medline
II Neutral (Yellow) ROSC, Survival to Discharge, Neuro intact Survival Patient PH-Paramedic Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
II Neutral (Yellow) ROSC, Survival to Admission/Discharge Process PH-Paramedic Cady. Effect of EMT Placed Combitube on OOH Arrest Outcomes. Prehosp Emergency Care 2009; 13(4):495-9. Medline
II Neutral (Yellow) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
II Neutral (Yellow) Successful insertion and ventilation Process Rumball C., Macdonald D., Barber P., Wong H., Smecher C. Endotracheal intubation and esophageal tracheal combitube insertion by regular ambulance attendants: A comparative trial. Prehosp Emerg Care 2004; 8(1):15-22. Medline
II Neutral (Yellow) Survival to discharge Patient PH-Paramedic Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
II Opposes (Red) Long-term Survival Patient PH-Paramedic Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
II Opposes (Red) Favourable neurological outcome 1 month Patient PH-Paramedic Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
III Supportive (Green) Rate of success, time to success Process SIM Bollig G., Lovhaug SW., Sagen O., Svendsen MV., Steen PA., Wik L. Airway management by paramedics using endotracheal intubation with a laryngoscope versus the oesophageal tracheal Combitube and EasyTube on manikins: a randomised experimental trial. Resuscitation 2006; 71(1):107-11. Medline
III Supportive (Green) Time to insertion, attempts Process SIM Calkins MD., Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma 1999; 46(5):927-32. Medline
III Supportive (Green) Successful insertion Process PH-Paramedic Davis DP., Valentine C., Ochs M., Vilke GM., Hoyt DB. The Combitube as a salvage airway device for paramedic rapid sequence intubation. Ann Emerg Med 2003; 42(5):697-704. Medline
III Supportive (Green) Speed of insertion Process Sanfilippo F., Chiarenza F., Maybauer DM., Maybauer MO. The Easytube for airway management: a systematic review of clinical and simulation studies. J Clin Anesth 2016; 31:215-22. Medline
III Neutral (Yellow) Success, Time to success, Practitioner preference Process SIM Tumpach EA., Lutes M., Ford D., Lerner EB. The King LT versus the Combitube: flight crew performance and preference. Prehosp Emerg Care 2009; 13(3):324-328. Medline
III Opposes (Red) Complications Patient PH-Paramedic Vezina MC., Trepanier CA., Nicole PC., Lessard MR. Complications associated with the esophageal-tracheal combitube in the pre-hospital setting. Can J Anesth 2007; 54:124-8. Medliine

I-Gel
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Success rate Process PH-Paramedic Duckett J, Fell P, Han K, Kimber C, Taylor C. Introduction of the I-gel supraglottic airway device for prehospital airway management in a UK ambulance service. Emerg Med J. 2014;31(6):505-507. doi:10.1136/emermed-2012-202126 Medline
III Supportive (Green) Device insertion time Process An J., Nam SB., Lee JS., Lee J., Yoo H., Lee HM., et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine 2017; 96(1):e5801. Medline
III Supportive (Green) Feasibility Process PH-Paramedic Benger J, Coates D, Davies S, et al. Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study. Br J Anaesth. 2016;116(2):262-268. doi:10.1093/bja/aev477 Medline
III Supportive (Green) First pass success. Process PH-Paramedic Häske D, Schempf B, Gaier G, Niederberger C. Performance of the i-gelTM during pre-hospital cardiopulmonary resuscitation.Resuscitation. 2013;84(9):1229-1232. doi:10.1016/j.resuscitation.2013.04.025 Medline
III Supportive (Green) Ventilatory success Patient PH-Paramedic Häske D, Schempf B, Niederberger C, Gaier G. i-gel as alternative airway tool for difficult airway in severely injured patients. Am J Emerg Med. 2016;34(2):340.e1-4. doi:10.1016/j.ajem.2015.06.008 Medline
III Supportive (Green) Successful Insertion Process PH-Paramedic Middleton PM, Simpson PM, Thomas RE, Bendall JC. Higher insertion success with the i-gel supraglottic airway in out-of-hospital cardiac arrest: a randomised controlled trial. Resuscitation. 2014;85(7):893-897. doi:10.1016/j.resuscitation.2014.02.021 Medline
III Supportive (Green) First pass success Process Wharton NM., Gibbison B., Gabbott DA., Haslam GM., Muchatuta N., Cook TM. I-gel insertion by novices in manikins and patients. Anaesthesia 2008; 63(9):991-5. Medline
III Opposes (Red) Ability to ventilate Process PH-Paramedic Baker PA, Webber JB. Failure to ventilate with supraglottic airways after drowning. Anaesth Intensive Care. 2011;39(4):675-677. http://www.ncbi.nlm.nih.gov/pubmed/21823389. Accessed March 13, 2019. Medline

Laryngeal Tube (with AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) First pass success rate Process Hilton MT., Wayne M., Martin-Gill C. Impact of System-Wide King LT Airway Implementation on Orotracheal Intubation. Prehospital emergency care 2016; 20(5):570-7. Medline
II Supportive (Green) Hospital mortality Patient PH-Paramedic Kempema J., Trust MD., Ali S., et al. Prehospital endotracheal intubation vs extraglottic airway device in blunt trauma. Am J Emerg Med 2015; 33(8):1080-3. Medline

Laryngeal Tube (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Modified Rankin Score at discharge or 30 days Patient Benger J., Kirby K., Black S., et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome The AIRWAYS-2 Randomized Clinical Trial. JAMA 2018; 320(8):779-791 Medline
I Supportive (Green) 72-hour survival Patient Wang H., Schmicker R., Daya M. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest A Randomized Clinical Trial. JAMA 2018; 320(8):769-778. Medline
I Neutral (Yellow) Ease of handling and efficacy of ventilation Process Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine; 25(1):104. Medline
II Supportive (Green) First pass and overall insertion success. Process Bernhard M., Gries A., Ramshorn-Zimmer A., Wenzel V., Hossfeld B. Insertion Success of the Laryngeal Tube in Emergency Airway Management. BioMed research international 2016; 3619159. Medline
II Supportive (Green) First pass success rate Process Hilton MT., Wayne M., Martin-Gill C. Impact of System-Wide King LT Airway Implementation on Orotracheal Intubation. Prehospital emergency care 2016; 20(5):570-7. Medline
II Supportive (Green) Success rate Process Hiltunen P., Jäntti H., Silfvast T., Kuisma M., Kurola J. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scandinavian journal of trauma, resuscitation and emergency medicine 2016;24:49. Medline
II Supportive (Green) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
II Supportive (Green) Multiple measures of chest compression interruptions Process Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-35. Medline
II Supportive (Green) One month survival with favorable neurological outcome Patient PH-Paramedic Kajino K., Iwami T., Kitamura T., et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011; 15(5):R236. Medline
II Supportive (Green) Chest compression Fraction Process PH-Paramedic Maignan M., Koch FX., Kraemer M., et al. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. Medline
II Supportive (Green) Adequate ventilation & oxygenation Process OR Noor ZM., Khairul FA. Comparison of the VBM laryngeal tube and LMA for ventilation during manual in-line neck stabilization. Singapore Med J 2006; 47:892-6. Medline
II Supportive (Green) Safety and feasibility Process PH-Paramedic Roth D., Hafner C., Aufmesser W., et al. Safety and feasibility of the laryngeal tube when used by EMTs during out-of-hospital cardiac arrest. Am J Emerg Med 2015; 33(8):1050-5. Medline
II Neutral (Yellow) EtCO2 during CPR Process Becker TK, Berning AW, Prabhu A, Callaway CW, Guyette FX, Martin-Gill C. An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways. Resuscitation 2018; 122:61-4. Medline
II Neutral (Yellow) ROSC, Survival to Discharge, Neuro intact Survival Patient PH-Paramedic Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
II Neutral (Yellow) Success, time Process OR Cavus E., Deitmer W., Francksen H., Serocki G., Bein B., Scholz J., et al. Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals. Eur J Anaesthesiol 2009; 26(9):730-35. Medline
II Neutral (Yellow) Chest compression interruptions Process Jarman AF., Hopkins CL., Hansen JN., Brown JR., Burk C., Youngquist ST. Advanced Airway Type and Its Association with Chest Compression Interruptions During Out-of-Hospital Cardiac Arrest Resuscitation Attempts. Prehosp Emerg Care 2017; 21(5):628-635. Medline
II Neutral (Yellow) Survival to discharge Patient PH-Paramedic Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
II Opposes (Red) Long-term Survival Patient PH-Paramedic Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
II Opposes (Red) Favourable neurological outcome 1 month Patient PH-Paramedic Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
II Opposes (Red) Sustained ROSC Patient PH-Paramedic McMullan J., Gerecht R., Bonomo .J, Robb R., McNally B., Donnelly J., Wang H. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation 2014; 85(5):617–22. Medline
II Opposes (Red) 30-day survival Patient Sulzgruber P., Datler P., Sterz F., Poppe M., Lobmeyr E., Keferböck M., et al. The impact of airway strategy on the patient outcome after out-of-hospital cardiac arrest: A propensity score matched analysis. Eur Heart J Acute Cardiovasc Care 2018; 7(5):423-431. Medline
III Supportive (Green) Ventilation Process SIM Dorges V., et al. Intubating laryngeal mask airway, laryngeal tube, 1100mL self-inflating bag-alternatives for BLS? Resus 2001; 51:185-91. Medline
III Supportive (Green) Successful insertion Process Frascone RJ. Use of King LTS-D with Medication Assisted A/W Management. Prehospital Emerg Care 2009; 13(4):541-5. Medline
III Supportive (Green) Correct placement and ventilation Process SIM Genzwuerker H, Hilker T, Hohner E, et al. The laryngeal tube: A new adjunct for airway management. Prehospital Emerg Care 2000; 4:168-72. Medline
III Supportive (Green) Correct placement and ventilation Process ED-MD Genzwuerker HV., Dhonau S., Ellinger K. Use of the laryngeal tube for out-of-hospital resuscitation. Resus 2002; 52:221-4. Medline
III Supportive (Green) Chest Compression Fraction Process SIM Jensen JL., Walker M., LeRoux Y., Carter A. Chest compression fraction in simulated cardiac arrest management by primary care paramedics: King laryngeal tube airway versus basic airway management. Prehosp Emerg Care 2013; 17(2):285-90. Medline
III Supportive (Green) Time to insertion and successful ventilation Process PH-Paramedic Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
III Supportive (Green) Time to insertion and successful ventilation Process PH-Paramedic Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
III Supportive (Green) Time to AW insertion Process SIM Reiter DA., Strother CG., Weingart SD. The quality of cardiopulmonary resuscitation using supraglottic airways and intraosseous devices: A simulation trial. Resuscitation 2013; 84(1):93-7. Medline
III Supportive (Green) Success rate of blind intubation Patient SIM Szarpak L., Kurowski A., Truszewski Z., Robak O., Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : A randomized controlled crossover trial. Am J Emerg Med 2015; 33(8):1084-1088. Medline
III Supportive (Green) Success, Time to success, Practitioner preference Process SIM Tumpach EA., Lutes M., Ford D., Lerner EB. The King LT versus the Combitube: flight crew performance and preference. Prehosp Emerg Care 2009; 13(3):324-328. Medline
III Neutral (Yellow) Desaturations Patient OR Kurola J., et al. Airway management in cardiac arrest - comparison of LT, TI, BMV in emergency medical training. Resus 2005; 61:149-53. Medline
III Neutral (Yellow) Success Process PH-Paramedic Kurola JO., et al. A comparison of the laryngeal tube & BMV ventilation by EMTs: a feasibility study in anesthetized patients. Anesth Analg 2005; 101:1477-81. Medline
III Neutral (Yellow) Successful insertion & ventilation Process PH-Paramedic Rumball CJ., MacDondald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1-10. Medline
III Neutral (Yellow) Success, time Process SIM Russi CS., Miller L., Hartley MJ. A comparison of the King-LT to ETI and Combitube in Simulated Difficult Airway. PEC 2008; 12:35-41. MedLine
III Neutral (Yellow) Functional of-hospital airway management in the United States Patient PH-Paramedic Wang HE., Mann NC., Mears G., Jacobson K., Yealy D. Out-of-hospital airway management in the United States. Resuscitation 2011; 82(4):378–385. Medline
III Neutral (Yellow) CPR (no flow time) Patient SIM Weise CHR., Bahr J., Popov AF., Hinz JM., Graf BM. Influence of airway management strategy on 'no flow time' in a standardized single rescuer manikin scenario. Resus 2009; 80:100-3. Medline
III Neutral (Yellow) Reduction in no flow time Patient SIM Wiese CH., Bartels U., Bergmann A., Bergmann I., Bahr J., Graf BM. Using a laryngeal tube during cardiac arrest reduces "no flow time" in a manikin study: A comparison between laryngeal tube and endotracheal tube. Wien Klin Wochenschr 2008; 120(7-8):217-223. Medline
X Not Yet Graded (White) - Fiala A., Lederer W., Neumayr A., Egger T., Neururer S., Toferer E., et al. EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial. Scandinavian journal of trauma, resuscitation and emergency medicine 2017; 25(1):104. Medline
X Not Yet Graded (White) - Wang CH, Lee AF, Chang WT, et al. Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials [published online ahead of print, 2020 Jan 23]. Ann Emerg Med. 2020;S0196-0644(19)31434-9. doi:10.1016/j.annemergmed.2019.12.003 Medline

LMA (with AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Hospital mortality Patient PH-Paramedic Kempema J., Trust MD., Ali S., et al. Prehospital endotracheal intubation vs extraglottic airway device in blunt trauma. Am J Emerg Med 2015; 33(8):1080-3. Medline
III Neutral (Yellow) Prevalence of LMA use Patient PH-Paramedic Hulme J., Perkins GD. Critically injured patients, inaccessible airways, and laryngeal mask airways. Emerg Med J 2005; 22:742-4. Medline

LMA (without AW reflexes)
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Ease and speed of placement Process OR Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 1995; 42(11):1017-23. Medline
I Neutral (Yellow) airway-related complications Patient OR Yu SH., Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxillofac Surg 2010; 68(10):2359-2376. Medline
II Supportive (Green) Success rate Process Hiltunen P., Jäntti H., Silfvast T., Kuisma M., Kurola J. Airway management in out-of-hospital cardiac arrest in Finland: current practices and outcomes. Scandinavian journal of trauma, resuscitation and emergency medicine 2016;24:49. Medline
II Supportive (Green) Adequate ventilation & oxygenation Process OR Noor ZM., Khairul FA. Comparison of the VBM laryngeal tube and LMA for ventilation during manual in-line neck stabilization. Singapore Med J 2006; 47:892-6. Medline
II Neutral (Yellow) Success Process OR Ali A., Canturk S., Turkmen A., Turgut N., Altan A. Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. Eur J Anaesthesiol 2009; 26(12):1010-4. Medline
II Neutral (Yellow) ROSC, Survival to Discharge, Neuro intact Survival Patient PH-Paramedic Benoit JL., Gerecht RB., Steuerwald MT., McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93:20-6. Medline
II Neutral (Yellow) Success, time Process OR Cavus E., Deitmer W., Francksen H., Serocki G., Bein B., Scholz J., et al. Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals. Eur J Anaesthesiol 2009; 26(9):730-35. Medline
II Neutral (Yellow) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
II Neutral (Yellow) One month survival with favorable neurological outcome Patient PH-Paramedic Kajino K., Iwami T., Kitamura T., et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011; 15(5):R236. Medline
II Neutral (Yellow) Arterial pH Patient PH-Paramedic SOS-KANTO study group. Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 2009; 73(3):490-496. Medline
II Neutral (Yellow) Survival to discharge Patient PH-Paramedic Wang H., Szydlo D., Stouffer J., Lin S., Carlson J., Vaillancourt C., Sears G., Verbeek R., Fowler R., Idris R., Koenig K., Christenson J., Minokadeh A., Brandt J., Rea T. Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation 2012; 83:1061-1066. Medline
II Neutral (Yellow) Success, time to ventilation Process OR Yardy N., Hancox D., Strang T. A comparison of two airway aids for emergency use by unskilled personnel. The Combitube and laryngeal mask. Anaesthesia 1999; 54(2):181-183. Medline
II Opposes (Red) Long-term Survival Patient PH-Paramedic Fouche PF., Simpson PM., Bendall J., Thomas RE., Cone DC., Doi SA. Airways in out-of-hospital cardiac arrest: Systematic review and meta-analysis. Prehosp Emerg Care 2014; 18(2):244-56. Medline
II Opposes (Red) Favourable neurological outcome 1 month Patient PH-Paramedic Hasegawa K., Hiraide A., Chang Y., Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA 2013; 309(3):257-66. Medline
II Opposes (Red) Neurologically favourable survival at one month Patient Ohashi-Fukuda N., Fukuda T., Yahagi N. Effect of pre-hospital advanced airway management for out-of-hospital cardiac arrest caused by respiratory disease: a propensity score-matched study. Anaesth Intensive Care 2017; 45(3):375-83. Medline
II Opposes (Red) Neurologically favorable 1-month survival Patient PH-Paramedic Tanabe S., Ogawa T., Akahane M., et al. Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: A nationwide, population-based, observational study. J Emerg Med 2013; 44(2):389-397. Medline
III Supportive (Green) Time to insertion, attempts Process SIM Calkins MD., Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma 1999; 46(5):927-32. Medline
III Supportive (Green) Ventilation Process SIM Dorges V., et al. Intubating laryngeal mask airway, laryngeal tube, 1100mL self-inflating bag-alternatives for BLS? Resus 2001; 51:185-91. Medline
III Supportive (Green) Success Process PH-Paramedic Grier G., Bredmose P., Davies G., Lockey D. Introduction and use of the ProSeal LMA as a rescue device in a prehospital trauma anaesthesia algorithm. Resus 2009; 80:138-41. Medline
III Supportive (Green) Successful insertion Process PH-Paramedic MacConachie-Middleton P., Simpson P., Thomas R., Bendall J. Higher insertion success with the i-gel® supraglottic airway in out-of-hospital cardiac arrest: A randomised controlled trial. Resuscitation 2014; 85:7:893–897. Medline
III Supportive (Green) Training success Process SIM Murray MJ., Vermeulen MJ., Morrison LJ. Evaluation of prehospital insertion of the laryngeal mask airway by primary care paramedics with only classroom mannequin training. CJEM 2002; 4:338-43. Medline
III Supportive (Green) Time to insertion and successful ventilation Process PH-Paramedic Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
III Supportive (Green) Time to insertion and successful ventilation Process PH-Paramedic Ono Y., Hayakawa M., Maekawa K., et al. Should laryngeal tubes or masks be used for out-of-hospital cardiac arrest patients? Am J Emerg Med 2015; 33(10):1360-3. Medline
III Supportive (Green) Time to AW insertion Process SIM Reiter DA., Strother CG., Weingart SD. The quality of cardiopulmonary resuscitation using supraglottic airways and intraosseous devices: A simulation trial. Resuscitation 2013; 84(1):93-7. Medline
III Supportive (Green) Time to placement Process SIM Southard A., Braude D., Crandall C. Rapid sequence airway vs rapid sequence intubation in a simulated trauma airway by flight crew. Resuscitation 2010; 81(5):576-578. Medline
III Supportive (Green) Success rate of blind intubation Patient SIM Szarpak L., Kurowski A., Truszewski Z., Robak O., Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : A randomized controlled crossover trial. Am J Emerg Med 2015; 33(8):1084-1088. Medline
III Supportive (Green) Endotracheal intubation (ETI) attempts, success rates Patient Thomas S., Judge T., Lowell MJ., et al. Airway management success and hypoxemia rates in air and ground critical care transport: A prospective multicenter study. Prehosp Emerg Care 2010; 14(3):283. Medline
III Neutral (Yellow) Success rate Process SIM Amathieu R., Sudrial J., Abdi W., Luis D., Hahouache H., Combes X., et al. Simulating face-to-face tracheal intubation of a trapped patient: a randomized comparison of the LMA Fastrach™, the GlideScope™, and the Airtraq™ laryngoscope. Br J Anaesth 2012; 108(1):140-5. Medline
III Neutral (Yellow) Device insertion time Process An J., Nam SB., Lee JS., Lee J., Yoo H., Lee HM., et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine 2017; 96(1):e5801. Medline
III Neutral (Yellow) Success and efficacy of ventilation Process SIM Fischer H., Hochbrugger E., Fast A., Hager H., Steinlechner B., Koinig H., et al. Performance of supraglottic airway devices and 12 month skill retention: a randomized controlled study with manikins. Resuscitation 2011; 82(3):326-31. Medline
III Neutral (Yellow) Prevalence of LMA use Patient PH-Paramedic Hulme J., Perkins GD. Critically injured patients, inaccessible airways, and laryngeal mask airways. Emerg Med J 2005; 22:742-4. Medline
III Neutral (Yellow) Successful insertion & ventilation Process PH-Paramedic Rumball CJ., MacDondald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1-10. Medline
III Neutral (Yellow) Functional of-hospital airway management in the United States Patient PH-Paramedic Wang HE., Mann NC., Mears G., Jacobson K., Yealy D. Out-of-hospital airway management in the United States. Resuscitation 2011; 82(4):378–385. Medline
X Not Yet Graded (White) - Shavit I., Aviram E., Hoffmann Y., Biton O., Glassberg E. Laryngeal mask airway as a rescue device for failed endotracheal intubation during scene-to-hospital air transport of combat casualties. European journal of emergency medicine 2018; 25(5) 368-71. Medline
X Not Yet Graded (White) - Wang CH, Lee AF, Chang WT, et al. Comparing Effectiveness of Initial Airway Interventions for Out-of-Hospital Cardiac Arrest: A Systematic Review and Network Meta-analysis of Clinical Controlled Trials [published online ahead of print, 2020 Jan 23]. Ann Emerg Med. 2020;S0196-0644(19)31434-9. doi:10.1016/j.annemergmed.2019.12.003 Medline

NPA
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Expiratory tidal volume Patient ED-MD Von Goedecke A. Optimising the unprotected airway with a prototype Jaw-Thrust-Device--a prospective randomised cross-over study. Anesthesia 2009; 64(11):1236-1240. Medline

OPA
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Expiratory tidal volumes, airway resistances, gas flow rates Patient OR Von Goedecke A. Optimising the unprotected airway with a prototype Jaw-Thrust-Device--a prospective randomised cross-over study. Anesthesia 2009; 64(11):1236-1240. Medline

Percutaneous Cricothyrotomy
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Success Process SIM Keane MF., Brinsfield KH., Dyer KS., Roy S., White D. A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel. Prehosp Emerg Care 2004; 8(4):424-6. Medline
II Neutral (Yellow) Success Process ED-MD Spaite DW., Joseph M. Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990; 19:279-285. Medline
II Opposes (Red) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
III Supportive (Green) Accuracy of placement Process ED-MD Chan TC., Vilke GM., Bramwell KJ., Davis DP., Hamilton RS., Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med 1999; 17(6):957-62. Medline
III Supportive (Green) Practitioner preference, time to ventilation, complications, number of attempts Patient SIM Sulaiman L., Tighe SQ., Nelson RA. Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion. Anaesthesia 2006; 61(6):565-570. Medline
III Neutral (Yellow) Time to first ventilation Process SIM Dimitriadis JC., Paoloni R. Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 2008; 63(11):1204-8. Medline
III Neutral (Yellow) Success rate on first attempt Process SIM Johnson DR., Dunlap A., McFeeley P., et al. Cricothyrotomy performed by prehospital personnel: A comparison of two techniques in a human cadaver model. Am J Emerg Med 1993; 11:207-9. Medline
III Neutral (Yellow) Time to successful cannulation Process ED-MD Kanji H., Thirsk W., Dong S., et al. Emergency cricothyroidotomy: A randomized crossover trial comparing percutaneous techniques: Classic needle first versus "incision first". Acad Emerg Med 2012; 19(9):E1061-7. Medline
III Neutral (Yellow) successful placement Process ED-MD Langvad S., Hyldmo PK., Nakstad AR., Vist GE., Sandberg M. Emergency cricothyrotomy--a systematic review. Scand J Trauma Resusc Emerg Med 2013; 21:43. Medline
X Not Yet Graded (White) - Dorsam JM., Cornelius SR., McLean JB., Zarow GJ., Walchak AC., Conley SP., et al. Randomized Comparative Assessment of Three Surgical Cricothyrotomy Devices on Airway Mannequins. Prehospital emergency care 2019; 23(3):411-9. Medline

Pharyngeal Tracheal Lumen (PTL)
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Success of airway management Patient PH-Paramedic Jensen JL., Cheung KW., Tallon JM., Travers AH. Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: A systematic review. CJEM 2010; 12(2):135-40. Medline
II Neutral (Yellow) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
III Neutral (Yellow) Successful insertion & ventilation Process PH-Paramedic Rumball CJ., MacDondald D. The PTL, combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1-10. Medline

Pressure manometer
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Peak inspiratory pressure Patient Anastácio de Lima F. C., Bastos l.p., Anderson F.V., Azevedo Schneider F.B., Coelho Y.L., Fernandes H.G.C. et.al. Benefits of Manometer in Non-Invasive Ventilatory Support. Prehosp Disaster Med. 2017;32(6):615-620. Medline

Surgical Cricothyrotomy
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Successful placement Process PH-Paramedic Brown LH., Hubble MW., Wilfong DA., Hertelendy A., Benner RW. Airway management in the air medical setting. Air Med J 2011; 30(3):140-8. Medline
II Supportive (Green) Success rate Patient PH-Paramedic Hubble MW., Wilfong DA.., Brown LH., Hertelendy A., Benner RW. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14(4):515-30. Medline
II Supportive (Green) Success Process SIM Keane MF., Brinsfield KH., Dyer KS., Roy S., White D. A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel. Prehosp Emerg Care 2004; 8(4):424-6. Medline
II Supportive (Green) Success rate Process PH-Paramedic & MD Schober P., Biesheuvel T., de LM, Loer SA., Schwarte LA. Prehospital cricothyrotomies in a helicopter emergency medical service analysis of 19,382 dispatches. BMC emergency medicine 2019; 19(1) 12. Medline
III Supportive (Green) Accuracy of placement Process ED-MD Chan TC., Vilke GM., Bramwell KJ., Davis DP., Hamilton RS., Rosen P. Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique. J Emerg Med 1999; 17(6):957-62. Medline
III Neutral (Yellow) Procedure duration, failure rate Process SIM Benkhadra M., Lenfant F., Nemetz W., Anderhuber F., Feigl G., Fasel J. A comparison of two emergency cricothyroidotomy kits in human cadavers. Anesth Analg 2008; 106(1):182-5. Medline
III Neutral (Yellow) Time to first ventilation Process SIM Dimitriadis JC., Paoloni R. Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 2008; 63(11):1204-8. Medline
III Neutral (Yellow) ROSC Process ED-MD Graham CA., Yu AH., Chan SS., Rainer TH. Primary emergency surgical airway for trismus caused by electrical burn. Burns 2006; 32(8):1062-3. Medline
III Neutral (Yellow) Correct diagnosis Process ED-MD Johnson DR., Dunlap A., McFeeley P., et al. Cricothyrotomy performed by prehospital personnel: A comparison of two techniques in a human cadaver model. Am J Emerg Med 1993; 11:207-9. Medline
III Neutral (Yellow) correct performance of intervention Patient PH-Paramedic Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
III Neutral (Yellow) successful placement Process ED-MD Langvad S., Hyldmo PK., Nakstad AR., Vist GE., Sandberg M. Emergency cricothyrotomy--a systematic review. Scand J Trauma Resusc Emerg Med 2013; 21:43. Medline
III Neutral (Yellow) Time to successful cricothyrotomy cannulation Process SIM Schauer SG., D FJ, L RJ, Brown D., L JK, Srichandra J., et al. A randomized cross-over study comparing surgical cricothyrotomy techniques by combat medics using a synthetic cadaver model. Am J Emerg Med 2018; 36(4) 651-6. Medline
III Neutral (Yellow) Safety and efficacy Patient PH-Paramedic Spaite DW., Joseph M. Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome. Ann Emerg Med 1990; 19:279-285. Medline
III Neutral (Yellow) Practitioner preference, time to ventilation, complications, number of attempts Patient SIM Sulaiman L., Tighe SQ., Nelson RA. Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion. Anaesthesia 2006; 61(6):565-570. Medline
III Neutral (Yellow) Success Patient ED-MD Walls RM., Pollack CV., Jr. Successful cricothyrotomy after thrombolytic therapy for acute myocardial infarction: a report of two cases. Ann Emerg Med 2000; 35(2):188-191. Medline
III Opposes (Red) Syncopal etiology Process ED-MD Fortune JB., Judkins DG., Scanzaroli D., et al. Efficacy of prehospital surgical cricothyrotomy in trauma patients. J Trauma, Injury, Infection and Critical Care 1997; 42:836-8. Medline


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