Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document

Airway management is a critical component of resuscitation but also carries the potential to disrupt perfusion, oxygenation, and ventilation as a consequence of airway insertion efforts, the use of medications, and the conversion to positive-pressure ventilation. NAEMSP recommends: Airway management should be approached as an organized system of care, incorporating principles of teamwork and operational awareness. EMS clinicians should prevent or correct hypoxemia and hypotension prior to advanced airway insertion attempts. Continuous physiological monitoring must be used during airway management to guide the timing of, limit the duration of, and inform decision making during advanced airway insertion attempts. Initial and ongoing confirmation of advanced airway placement must be performed using waveform capnography. Airway devices must be secured using a reliable method. Perfusion, oxygenation, and ventilation should be optimized before, during, and after advanced airway insertion. To mitigate aspiration after advanced airway insertion, EMS clinicians should consider placing a patient in a semi-upright position. When appropriate, patients undergoing advanced airway placement should receive suitable pharmacologic anxiolysis, amnesia, and analgesia. In select cases, the use of neuromuscular blocking agents may be appropriate.