Category: Supraglottic Airway

Supraglottic Airway

Question#: 544

Question:

In the setting of a cardiac arrest, a supraglottic airway (SGA) is inserted for ventilatory assistance and/or airway control.



Within the ALSPCS Companion document it defines active vomiting as "active vomiting is considered ongoing vomiting where the paramedic is unable to clear the airway. In this situation, the SGA should not be inserted." It also states that "if the patient has vomited, and the airway has been cleared successfully, an SGA may be inserted".



In the situation where a SGA has been inserted into a patient without vital signs (apneic/pulseless), and passive regurgitation occurs, where stomach contents are seen in the oral pharynx and are easily suctioned, is the SGA required to be removed? For clarity, there is no retching, patient remains pulseless and apneic.



Several clinicians within our service (ACP & PCP) believe this is a requirement as the feeling is that this is 'active vomiting'.



Could we get clarification?



Thanks in advance,

Answer:

Supraglottic Airways (SGAs) are not perfect devices, there is always a risk of aspiration. In a VSA patient, obtaining an airway is crucial, even though there is a possibility of regurgitation.

If the patient regurgitates but there is chest rise, and an End Tidal CO2 reading and wave form are present, then assume that the SGA is doing a good job. At this stage it would be more dangerous to remove the SGA, due to greater risk of aspiration and loss of the airway.

Continue ventilating with the SGA in place and use the suction to aspirate any visible regurgitation.

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