Airway Adjuncts Research Articles

Comparative evaluation of efficacy of oxygenation using high flow nasal cannula vs. conventional nasal cannula during procedural sedation for endoscopic ultrasound: A pilot study.

Background and Aims:High flow nasal cannula (HFNC) has numerous advantages against conventional oxygen therapy delivery systems. However, there is limited evidence supporting the use of HFNC in endoscopic ultrasound (EUS) under procedural sedation. The aims of this study is to evaluate the efficacy of two different oxygen delivery devices, that is,HFNCand conventional nasal cannula on the oxygenation status of patients during procedural sedation for EUS.Material and Methods:Sixty adult patients undergoing EUS for various ailments were randomized to two groups group HFNC (n=30) and group nasal cannula [NC (n = 30)]. HFNC (AIRVO2, Fisher and Paykel Healthcare, New Zealand) was used on patients in the group HFNC. Respiratory status of the patients was assessed using pulse oximetry, respiratory rate, procedural airway complications, and oxygen therapy adjustments. The endoscopist assessed the ease of performing EUS at the end of the procedure and patient satisfaction score (PSS) was assessed by using a Likert score in the post-anesthesia care unit.Results:SpO2 measurements in the HFNC group during the procedure were marginally better compared to the NC group but this failed to reach statistical significance. Also, no significant association was found between both groups while comparing desaturation events (P = 0.499), patient satisfaction score (PSS) and endendoscopist’s satisfaction score (ESS) (P = 0.795). Both the groups were comparable in terms of airway manipulation, use of airway adjuncts, need to increase oxygen flow rate, endoscope removal, apneic episodes, hypotension, and bradycardia. No major complications were observed in either group.Conclusion:HFNC use in patients undergoing EUS is not superior when compared to conventional nasal cannula oxygen therapy. HFNC failed to show any significant impact on decreasing the risk of desaturation events and airway manipulation during the procedure.

Unanticipated Difficult Airway Management in a Trauma Partient with Severe Ankylosing Spondylitis

Ankylosing Spondylitis is a debilitating chronic arthropathy that affects multiple joints. Anaesthesiologists face significant challenges when dealing with the airway implications of this disease, especially when it is unanticipated that a difficult airway may be encountered. This case describes a 42-year-old trauma victim who required an emergency denitive trachea at his ward. Ankylosing Spondylitis and complex airway anatomy led to his intubation failure. He was eventually given an emergency surgical tracheostomy. The successful management of a difficult airway was possible thanks to the appropriate use of modern airway adjuncts as well as workplace soft skills.

UNANTICIPATED DIFFICULT AIRWAY MANAGEMENT IN A TRAUMA PATIENT WITH SEVERE ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is a chronic debilitating arthropathy affecting multiple joints in the body. Airway implications related to the disease pose a signicant challenge to the anaesthesiologists especially when an unanticipated difcult airway is encountered. A case of 42 year old trauma victim who needed an emergency denitive airway at ward set up, is reported here. Failed intubation due to complex airway anatomy associated with ankylosing spondylitis ensued him being ended up with an emergency surgical tracheostomy. Appropriate use of newer airway adjuncts and workplace soft skills contributed to successful management of an unanticipated difcult airway.

Endotracheal Intubation with Laryngeal Mirror in Simulated Difficult Direct Laryngoscopy: Comparison of Gum Elastic Bougie Versus Styleted Endotracheal Tube.

Laryngeal mirror (LM) is an inexpensive, portable, readily available device which can help visualize the vocal cords in difficult airway (DA) situations. We evaluated its use in improving glottic view prior to placing the airway adjuncts in simulated difficult airway.Eighty patients scheduled to undergo elective surgery under general anaesthesia with endotracheal intubation were allocated- Bougie group (Group B) and Stylet group (Group S). Direct laryngoscopy was performed and CL grade III simulated. The glottic view was obtained using laryngeal mirror and Gum Elastic Bougie (GEB)/ Styleted Endotracheal Tube (ETT) inserted under mirror view. Time taken to obtain glottic view in LM and time for successful intubation were noted.Significant improvement in glottic view with LM was observed, with the view improving to Grade I in 76.25% and grade II in 23.75% of patients. Both groups were comparable with respect to number of attempts and success rate (p = 0.55).The success rate was 90% in group B and 95% in group S. Time taken for intubation was less in Group S (52.44 ± 14.23s vs. 62.805 ± 20.74s) [p = 0.01]. Hence, overall stylet proved to be a better adjunct with mirror guided intubation.We recommend stylet assisted rather than GEB assisted ET intubation under LM guidance in emergency scenarios. Also, further controlled trials are recommended to know the exact location of the mirror in relation to bulb of the laryngoscope as well as different angles at which it is placed to improve the view and stabilize the assembly.

An Analysis of Airway Interventions in the Setting of Smoke Inhalation Injury on the Battlefield.

The Committee on Tactical Combat Casualty Care and Capabilities Development and Integration Directorate cite airway burn injuries as an indication for prehospital cricothyrotomy. We sought to build on previously published data by describing for the first time the incidence of prehospital airway interventions in combat casualties who received airway management in the setting of inhalational injuries.15,26 We hypothesized that (1) airway interventions in combat casualties who suffered inhalational injury would have a higher mortality rate than those without airway intervention and (2) prehospital cricothyrotomy was used with greater incidence than endotracheal intubation. Using a previously described Department of Defense Trauma Registry dataset from January 2007 to August 2016, unique casualties with documented inhalational injury were identified. Our predefined search codes captured 28,222 (72.8% of all encounters in the registry) of those subjects. A total of 347 (1.2%) casualties had a documented inhalational injury, 27 (7.8%) of those with at least 1 prehospital airway intervention inhalational injuries (0.09% of our dataset [n = 28,222]). Within the subset of patients with an inhalation injury, 23 underwent intubation, 2 underwent cricothyrotomy, 3 had placement of an airway adjunct not otherwise specifically listed, and 1 casualty had both a cricothyrotomy and intubation documented. No casualties had a supraglottic, nasopharyngeal, or oropharyngeal airway listed. Contrary to our hypotheses, of those with an airway intervention, 74.0% survived to hospital discharge. In multivariable regression models, when adjusting for confounders, there was no difference in survival to discharge in those with an airway intervention compared to those without. Casualties undergoing airway intervention for inhalation injuries had similar survival adjusting for injury severity, supporting its role when indicated. Without case-specific data on airway status and interventions, it is challenging to determine if the low rate of cricothyrotomy in this population was a result of rapid transport to a more advanced provider capable of performing intubation or cricothyrotomy may not be meeting the needs of the medics.

Comparison of Confirmation of Placement of Laryngeal Mask Airway by Fiberoptic Laryngoscope and Ultrasound Examination

Abstract Background: The laryngeal mask airway (LMA) is widely used as an effective and safe airway adjunct in the routine practice of anesthesia. There are various methods to assess the correct placement, the gold standard being fiberoptic visualization through the LMA. Ultrasound (USG) is a noninvasive, readily available diagnostic tool and has been used with increased frequency for airway examination. The aim of our study was comparison of fiberoptic and USG evaluation for the confirmation of placement of LMA. Patients and Methods: This was a cross-sectional observational study conducted on 250 patients of American Society of Anesthesiologists Grade 1 and 2, in the age group of 18–65 years undergoing elective surgery under general anesthesia with LMA. The position of the LMA cuff was confirmed by USG and reconfirmed with fiberoptic laryngoscopy (FOL). Results: We observed that the USG Grade 1 was seen in 76.8% of patients as compared to FOL Grade 1 seen in 81.6%. The frequency of LMA misplacement (i.e., Grades 2–4) noted with USG was 23.2% and with FOL was 18.4%. The Bland–Altman scatter plot showed insignificant differences between the two grading systems (near-zero mean: 0.05), with small limits of agreement (−0.509 to +0.609). Conclusion: USG can replace fiberoptic examination for confirmation of the correct placement of an LMA. USG can further give insight into the grading of LMA placement and the cause of airway and ventilation events, which can be corrected and prevented.

Shoulder surgery using combined regional and general anesthesia versus regional anesthesia and deep sedation with a non-invasive positive pressure system: A retrospective cohort study

BackgroundThere are benefits to choosing deep sedation over general anesthesia as an intraoperative anesthetic for shoulder surgery. Deep sedation, however, may be challenging in patients with risk factors for hypoxemia. MethodsWe conducted a retrospective case control study comparing patients who underwent shoulder surgery using deep sedation and interscalene block versus general anesthesia and cervical paravertebral or interscalene block. A non-invasive positive pressure system (SuperNO2VA mask; Vyaire Medical, Mettawa, IL, USA) was utilized as an airway adjunct in patients undergoing deep sedation. ResultsSixty patients were included in the study (20 patients with block with sedation and 40 patients with general anesthesia). No patient who received deep sedation required conversion to general anesthesia or additional airway support measures. Induction- and emergence-related anesthesia times were lower for those who received deep sedation than those who received general anesthesia (39 [CI 31–48] vs 17 [CI 8–27] minutes; p < 0.0001). No differences were detected in post-anesthesia care unit times, operative times, or estimated blood loss between the two groups. Intravenous fluid administration was lower in patients receiving deep sedation. Sixty percent of patients under general anesthesia had a urinary catheter placed versus zero in the deep sedation group. Vasopressor administration was more common in the general anesthesia group, while antihypertensive medications were utilized more frequently in the deep sedation group. ConclusionsThis retrospective study showed that non-invasive positive pressure ventilation facilitated the performance of deep sedation for shoulder surgery with an interscalene block for both shoulder arthroscopic procedures and shoulder arthroplasty. This technique was associated with avoidance of mechanical ventilation, decreased anesthesia time, use of vasopressors, and need for urinary catheter placement.

Pediatric Airway Assessment Tool (PAAT): A Rating Tool to Assess Resident Proficiency in Simulated Pediatric Airway Skills Performance.

IntroductionThe Accreditation Council for Graduate Medical Education has identified the need for assessment of core skills for pediatric and emergency medicine residents, which includes pediatric airway management. Although there are standard courses for pediatric airway management, there is no validated tool to assess basic and advanced pediatric airway skills performance. Our objective was to develop a simulation-based tool for the formative assessment of resident pediatric airway skills performance that was concise, yet comprehensive, and to evaluate the evidence supporting the argument for the tool's validity.MethodsWe developed a pediatric airway assessment tool (PAAT) to assess six major domains of pediatric airway skills performance: basic airway maneuvers, airway adjuncts, bag-valve mask ventilation, advanced airway equipment preparation, direct laryngoscopy, and video laryngoscopy. This tool consisted of a 72-item pediatric airway skills assessment checklist to be used in simulation. We enrolled 12 subjects at four different training levels to participate. Assessment scores were rated by two independent expert raters.ResultsThe interrater agreement was high, ranging from 0.92 (adult bagging rate) to 1 (basic airway maneuvers). There was a significant trend of increasing scores with increased training level.DiscussionThe PAAT demonstrated excellent interrater reliability and provided evidence of the construct's validity. Although further validation of this assessment tool is needed, these results suggest that the PAAT may eventually be useful for assessment of resident proficiency in pediatric airway skills performance.

Airway Management in out of the Operating Room Environments

This review explores the expanding considerations and techniques for airway management of patients in remote settings outside of the operating room (OR). These environments bring various challenges for the patient as well as practitioner and it is essential to proceed safely. New developments in patient monitoring, oxygen delivery, and airway adjuncts have provided solutions to the many challenges involved in management of the airway in remote environments. These devices and techniques may have had their origins in the operating room but are uniquely applicable to outside locations. Currently, few studies are available but clinical experience is leading the way. Diagnostic and therapeutic procedures in remote locations constitute a significant portion of anesthetic care that is required increasingly for patient management. Given the frequent number of complex patients involved, it becomes necessary to employ the safest and most efficient techniques to accomplish these goals. The goals for airway management continue to be oxygenation and ventilation with the protection from gastric aspiration when at risk.

International Pediatric Otolaryngology Group (IPOG): Consensus recommendations on the prenatal and perinatal management of anticipated airway obstruction

ObjectiveTo make recommendations on the identification, routine evaluation, and management of fetuses at risk for airway compromise at delivery. MethodsRecommendations are based on expert opinion by members of the International Pediatric Otolaryngology Group (IPOG). A two-iterative Delphi method questionnaire was distributed to all members of the IPOG and responses recorded. The respondents were given the opportunity to comment on the content and format of the survey, which was modified for the second round. “Consensus” was defined by >80% respondent affirmative responses, “agreement” by 51–80% affirmative responses, and “no agreement” by 50% or less affirmative responses. ResultsRecommendations are provided regarding etiologies of perinatal airway obstruction, imaging evaluation, adjunct evaluation, multidisciplinary team and decision factors, micrognathia management, congenital high airway obstruction syndrome management, head and neck mass management, attended delivery procedure, and delivery on placental support procedure. ConclusionsThorough evaluation and thoughtful decision making are required to optimally balance fetal and maternal risks/benefits.

A simplified approach for anaesthetic management of diagnostic procedures in children with anterior mediastinal mass.

Children with an anterior mediastinal mass (AMM) need general anaesthesia (GA) or deep sedation for diagnostic procedures more often than adult patients. Anaesthetic management to prevent such complications includes maintenance of spontaneous ventilation (SV) and prebiopsy corticosteroids/radiotherapy. We reviewed the medical records of children with AMM who were brought to the operating theatre for diagnostic procedures (prior to chemotherapy) between 2001 and 2013. Our aim was to describe the clinical features, radiological findings and anaesthetic management, as well as determine any association with complications. 25 patients (age range 10 months-14 years) were identified during the study period. Corticosteroid therapy was started before the biopsy for one patient. All 25 patients had GA/sedation. A senior paediatric anaesthesiologist was involved in all procedures. Among 13 high-risk patients, SV was maintained in 11 (84.6%) patients, ketamine was used as the main anaesthetic in 8 (61.5%) patients, 6 (46.2%) patients were in a sitting position and no airway adjunct was used for 7 (53.8%) patients. There were 3 (12.0%) minor complications. Based on our results, we propose a simplified workflow, wherein airway compression of any degree is considered high risk. For patients with high-risk features, multidisciplinary input should be sought to decide whether the child would be fit for a procedure under GA/sedation or considered unfit for any procedure. Recommendations include the use of less invasive methods, involving experienced anaesthesiologists to plan the anaesthetic technique and maintaining SV.

Lower maximum forces on oral structures when using gum-elastic bougie than when using endotracheal tube and stylet during both direct and indirect laryngoscopy by novices: a crossover study using a high-fidelity simulator

BackgroundApplying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet.MethodsThis prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically.ResultsThe maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001).ConclusionsCompared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways.

Paramedics and pneumonia associated with COVID-19

Paramedics are at the frontline of healthcare delivery and this includes during the current coronavirus pandemic. This pandemic poses specific problems for paramedics, which include not only treating and transporting infected patients, but also issues around decontamination and disinfection of ambulances and medical equipment. Of particular concern is the pneumonia associated with the 2019 novel coronavirus. Data on COVID-19 pneumonia are developing. Ongoing research demonstrates that almost all serious consequences of COVID-19 feature pneumonia, especially in older people and those with comorbidities. Paramedics can have a profound effect on the care of patients with pneumonia. Effective management of COVID-19 pneumonia by the paramedic should centre around prompt recognition, early administration of oxygen and intravenous fluids and transfer to hospital. In some situations, paramedics may need to be involved in the delivery and maintenance of airway adjuncts in patients with COVID-19 pneumonia.

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

BackgroundIncidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists.MethodsWe conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression.ResultsThirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.ConclusionIn this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie.Trial registrationclinicaltrials.gov Identifier: NCT03733158. 7th November 2018.

Multidisciplinary Simulation Training Improves Surgical Resident Comfort With Airway Management

BackgroundAirway management is an essential element of surgical training, but with fewer procedures performed during residency, simulation is crucial to fill educational gaps. We evaluated the effect of a multidisciplinary airway simulation on the comfort of general surgery residents in managing airways. Materials and methodsAll residents PGY 2-5 at a large academic general surgery residency program participated in a multidisciplinary airway management simulation. Precourse surveys evaluated self-perception of skills in three areas of airway management: surgical airway, basic ventilator strategies, and endotracheal intubation. Simulation consisted of didactic and procedural components and used high- and low-fidelity models including silicon airways, ventilators, porcine trachea, and airway adjuncts. Instruction was provided by anesthesia and otolaryngology faculty. Postcourse assessment was performed with a four-level Likert questionnaire. Results were analyzed using paired t-tests. ResultsOf the 19 residents surveyed, 37% of residents had 1-5 h and 32% had 5-10 h of prior airway instruction. Significant increases in mean comfort were observed across all three studied areas. Residents reported increased comfort performing a surgical airway (1.16 versus 1.95), P < 0.0001, and troubleshooting ventilator issues (1.59 versus 2.16), P < 0.0001. Comfort regarding overall airway management including endotracheal intubation demonstrated similar improvement (1.84 versus 2.32), P = 0.02. Subgroup analysis by PGY level showed the greatest impact on comfort level in junior residents. ConclusionsMultidisciplinary airway simulation can be effectively implemented in a general surgery training program and positively affect trainee comfort with these techniques, particularly among junior residents.

Ancillary protective gears in the COVID- 19 Era.

Ancillary protective gears in the COVID- 19 Era.

A comparison of direct laryngoscopy versus videolaryngoscopy using aerosol box for intubation in emergency surgeries during Covid-19 pandemic: A pilot study

Background and Aims: This study was planned to compare intubating conditions with aerosol box, while attempting intubation with either direct laryngoscope (DL) using Macintosh blade or McGrath MAC™, videolaryngoscope (VL). Methodology: Sixty adult patients coming for the emergency surgeries during COVID-19 pandemic were divided equally by consecutive sampling into either Group 1 (DL) or Group 2 (VL). General anesthesia was administered with aerosol box covering the head and trunk of the patient. The laryngoscopy was attempted based on the group allocation with either VL or DL through aerosol box. Following observations were noted, total intubation time, number of attempts, Cormack–Lehane (CL) view, intubation difficulty scale (IDS), use of airway adjuncts, and external laryngeal maneuver. Results: Mean (standard deviation) time taken to intubate was 25.36 (6.22) sec in DL group and 21.9 (5.56) sec in VL group. Median IDS scoring was 1 in DL group and 0 in VL group indicating toward ease of intubation with the videolaryngoscope. Improved glottic view (CL Grade 1) was attained commonly with VL group and higher CL grades (2b) were common with DL group (23.3%). No intubation aids were required in VL group although 30% in DL required bougie for the intubation. External laryngeal maneuver was applied in 40% subjects undergoing DL with no maneuvers needed in VL group. First pass success of intubation was comparable in both the groups. Conclusion: Intubating conditions are favorable with VL when aerosol box is included which requires acquisition of the skills depending on its availability. However, the intubation should be attempted with the technique the clinician has the expertise during this pandemic.

Preparedness to combat COVID-19 via structured online training program regarding specific airway management: A prospective observational study.

Preparedness to combat COVID-19 via structured online training program regarding specific airway management: A prospective observational study.

U.S. Military Medical Evacuation and Prehospital Care of Pediatric Trauma Casualties in Iraq and Afghanistan

Background: Traumatic injuries were the most common reason for pediatric admission to military hospitals during the recent wars in the Middle East. We describe injury characteristics and prehospital interventions performed on wartime pediatric trauma casualties in Afghanistan and Iraq, stratified by medical evacuation platform. Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (age < 18 years) encounters from January 2007 to January 2016. The DODTR is the data repository for all trauma-related injuries managed by deployed US military medical treatment facilities with surgical capabilities. We requested all documented prehospital care, which may have been delivered anywhere from the point-of-injury until a fixed-facility with surgical capabilities. We stratified subjects according to Centers for Disease Control age groupings: <1 year, 1–4 years, 5–9 years, 10–14 years, and 15–17 years. Results: Of the 3,493 pediatric encounters in the DODTR, 1,004 underwent military evacuation from the point of injury: 911 (90.7%) by standard medical evacuation platforms and 93 (9.3%) by nonstandard, improvised evacuation assets. Six hundred seventy-five of the 1004 pediatric trauma casualties were between 5 and 14 years of age. Over 75% were male, over 80% were in Afghanistan, and most were injured by explosives. Across all age groups, serious injuries to the head/neck and extremities were most common. Subjects transported by standard evacuation platforms underwent tourniquet application (12.2% vs 5.3%, p < 0.05) and intraosseous access (12.2% vs 4.3%; p = 0.02) more frequently than those on nonstandard platforms. Casualties evacuated by nonstandard platforms underwent airway adjunct emplacement more frequently those on standard evacuation assets (3.2% vs 0.3%; p = 0.01). IV access and opiate administration were the most commonly performed interventions on both standard and nonstandard assets. Subject survival to hospital discharge was 88.1% on standard platforms and 89.2% on nonstandard platforms (p = 0.75). Conclusions: Approximately 30% of pediatric trauma casualties in Afghanistan and Iraq underwent medical evacuation from the point of injury directly to a military treatment facility with surgical capabilities. Most of those children did not undergo the prehospital interventions studied. Future investigations evaluating pediatric medical evacuation and prehospital care, medical staffing, pediatric-specific training, and equipping of pediatric-specific materials may be beneficial.

Advancing emergency airway management practice and research.

Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.