Two Trials Support High-Flow Oxygen Use in Patients with Hypoxemic Respiratory Failure

Patricia Kritek, MD   In one trial, intubation rates were similar to those of noninvasive positive pressure ventilation, and 90‐day mortality was lower.   Use of noninvasive positive pressure ventilation (NPPV) in patients with chronic obstructive pulmonary disease exacerbations and cardiogenic pulmonary edema is well established, but its value in treating patients with hypoxemic respiratory... Read more..

Rise in Video Laryngoscopy Has Not Affected Rates of Awake Intubation

Calvin A. Brown, III, MD   In this retrospective review at a single center use of video laryngoscopy increased significantly over time, but the rate of awake intubation remained constant.   Awake intubation is used when glottic visualization with a laryngoscope and rescue mask ventilation are anticipated to be significantly difficult. It involves the use... Read more..

Supplemental Oxygen is Not Needed for STEMI Patients with Normal Oxygen Saturations

Ali S. Raja, MD, MBA, MPH, FACEP   Outcomes were either similar or worse for STEMI patients given supplemental oxygen, compared with those who maintained a saturation ≥94% on their own.   Supplemental oxygen likely provides no benefit to — and may even harm — patients with chronic obstructive pulmonary disease or other causes of dyspnea... Read more..

Trainees Using Video Laryngoscopy Are Less Likely to End Up in the Esophagus

Ali S. Raja, MD, MBA, MPH, FACEP   The odds of an emergency medicine resident intubating a patient's esophagus were nearly 7 times higher with direct, rather than video, laryngoscopy.   While video laryngoscopy results in consistently improved glottic views compared with direct laryngoscopy, its benefits in terms of intubation success may be mitigated... Read more..

Intubation vs. Supraglottic Airway for Out-of-Hospital Cardiac Arrest

Daniel M. Lindberg, MD   Endotracheal intubation had a small but consistent benefit across several outcomes in this systematic review of observational studies.   While quality advanced life support can certainly be critical for patients with out-of-hospital cardiac arrest, there is no robust evidence that early intubation improves outcomes, and many prehospital providers have... Read more..

Successful Difficult Airway Intubation Using the Miller Laryngoscope Blade and Paraglossal Technique, May 2015

P Anderson, J Espanaco Valdés, JG Vorster South African Journal of Anaesthesia and Analgesia, May  2015 Abstract: In anaesthetic practice clinicians are often faced with difficult airway situations. The conventional approach to intubation is the midline technique using a curved Macintosh blade for direct laryngoscopy. However, we have been successful in such a... Read more..

High-Flow Nasal Cannula Oxygen Does Not Prevent Desaturation During Intubation

Daniel M. Lindberg, MD   In an unblinded, randomized trial of ICU patients with hypoxemic respiratory failure, high-flow nasal cannula oxygenation did not reduce desaturation during intubation.   Despite adequate preoxygenation, desaturation is common during endotracheal intubation in patients with respiratory disease. The use of high-flow nasal cannula oxygenation has recently been proposed to... Read more..

The Difficult Airway with Recommendations for Management – Part 2 – The Anticipated Difficult Airway, October 2013

Law JA, et al. Can J Anaesth. 2013 Nov;60(11):1119-38.



Appropriate planning is crucial to avoid morbidity and mortality when difficulty is anticipated with airway management. Many guidelines developed by national societies have focused on management of difficulty encountered in the unconscious patient; however, little guidance appears in the literature on how... Read more..

The Difficult Airway with Recommendations for Management — Part 1 — Difficult Tracheal Intubation Encountered in an Unconscious/Induced Patient, October 2013

Law JA, et al. Can J Anaesth. 2013 Nov; 60(11): 1089-118



Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publications.  The CAFG has since reconvened to examine more recent scientific literature on airway management.  the... Read more..

Ketamine – A Narrative Review of Its Uses in Medicine, April 2015

BM Radvansky, S Puri, AN Sifonios, JD Eloy, V Le Am J Ther 2015 Apr 24 Abstract: One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic... Read more..

How Uncomfortable is High-Flow Oxygen via Nasal Cannula

Daniel J. Pallin, MD,mp H   Normal volunteers tolerated a flow rate of 15L/minute but found it more uncomfortable than 6 L/minute.   A new technique called “apneic oxygenation” is purported to prevent desaturation by delivering high-flow oxygen via nasal cannula to ventilate the lungs passively just before intubation. But could this cause patient... Read more..

Tuesday EMS Tidbits – Airway Management – featuring Dr. Michael F. Murphy and Michael Keller

Link to the Tuesday EMS Tidbits podcast hosted by Bradley Dean, David Blevins, and Eric McCullough. This episode features Dr. Michael F. Murphy and Mr. Michael Keller discussing the difficult airway and how practitioners can overcome these challenging situations. Read more..

“Outside-The-Box” featuring Ron M. Walls, MD – from the Boston Business Journal

The Boston Business Journal recently sat down with Ron M. Walls, founder of The Difficult Airway Course, to talk about his new role as Executive Vice President and Chief Operating Officer of Brigham & Women's Hospital in Boston, Massachusetts.  Read the complete article here. Read more..

Factors Associated with Desaturation in Pediatric Intubations

<i><strong>Katherine Bakes, MD</strong></i> &nbsp; <i>Longer duration of intubation attempt, but not number of attempts, was associated with desaturation, particularly in children younger than 24 months.</i> &nbsp; In a prior study of pediatric rapid sequence intubation, oxyhemoglobin desaturation (SpO2 <90%) occurred in 33% of 144 children (half younger than 24 months) who underwent 221 intubations... Read more..

March 2015 Quarterly Airway Management Research Update

Originally presented as a live webinar, Dr. Calvin A. Brown, III uses case discussions to introduce the latest published airway research and discusses their impact on clinical practice. Read more..

High vs. Low Tidal Volume Ventilation for Inhalational Burn Injuries in Children

Cheryl Lynn Horton, MD   Some outcomes appeared to be better with high tidal volume ventilation, but this study should not change practice.   To compare the effects of low versus high tidal volume ventilation in pediatric patients with inhalational burns, researchers from a single burn hospital reviewed outcomes for 932 patients with confirmed... Read more..

KARL STORZ C-MAC USB Video Laryngoscope System among EMS World Top Innovation Award Recipients for 2014

KARL STORZ Endoscopy-America, Inc., announced today that it's C-MAC® S USB Video Laryngoscope System was selected as one of EMS World magazine's Top 20 Innovations for 2014. Products that receive the award are described by the publication as leading examples of how technology, engineering and creativity have been applied in... Read more..

Bedside Transtracheal Ultrasound Accurately Confirms Endotracheal Tube Placement

R. Eleanor Anderson, MD;  Calvin A. Brown, III, MD, FAAEM   In a meta-analysis, transtracheal ultrasound was highly sensitive and specific for detecting tracheal placement during emergency intubation.   In the emergency department (ED), colorimetric or quantitative capnography is the gold standard for confirmation of endotracheal tube placement. Capnography may be unreliable in patients... Read more..

GlideScope VL Improves Success of Urgent Intubation by Critical Care Physicians

Calvin A. Brown, III, MD, FAAEM   In a randomized study, first-attempt intubation success was nearly twice as high with GlideScope video laryngoscopy compared with direct laryngoscopy in intensive care patients.   Use of video laryngoscopy (VL) results in improved glottic views, fewer intubation attempts, and higher intubation success in both operating room and... Read more..

Prehospital/EMS Articles of the Year Selected by

PHARM: Prehospital and Retrieval Medicine ( a blog produced by Dr. Minh Le Cong of Australia, has posted its 2014 Prehospital/EMS Articles of the Year, which includes the following four articles relating to airway management.  Visit for the complete listing of all categories.   Wimalasena Y, Burns B, Reid C,... Read more..

Predicting Difficult Airways: 3-3-2 Rule or 3-3 Rule? March 2015

T Yu, B Want, X J Jin, R R Wu, H Wu, J J He, D Yao, Y H Li Irish Journal of Medical Science 2015 March 5 Background: The goal of this study was to assess the value of the 3-3 rule and the 3-3-1 rule in predicting difficult airways. Methods: The... Read more..

Emergency Department Intubations Are Increasingly Successful

Ali S. Raja, MD, MBA, MPH, FACEP   First-pass ED intubation success increased from 80% in 2002 to 86% in 2012, with concomitant increases in the use of video laryngoscopy and rocuronium.   Emergency department (ED) intubation is constantly evolving, with new devices, techniques, and medications being frequently adopted. To evaluate temporal trends, National... Read more..

Failed Intubation Attempt in the ED? Switch to Video Laryngoscopy

Ali S. Raja, MD, MBA, MPH, FACEP   After an initial failure, emergency department intubators were more successful with the C-MAC video laryngoscope than with a direct laryngoscope, regardless of which device was used initially.   Although video laryngoscopy has repeatedly been shown to be superior to direct laryngoscopy (NEJM JW Emerg... Read more..

Another Retrospective Observational Study Criticizes Etomidate

Daniel J. Pallin, MD, MPH   Yet another attempt to use retrospective methods to discredit a valuable medication   Etomidate is one of the standard agents for induction during rapid sequence intubation when cardiovascular stability is a concern, because it causes minimal hypotension and has a very short duration of action. Randomized trials have... Read more..

A Prehospital Apneic Oxygenation Protocol Correlates with Fewer Desaturations

Daniel J. Pallin, MD, MPH   But reasons why are not clear from this study.   Prior small studies have demonstrated that paralyzed patients desaturate less rapidly when high –flow oxygen is provided via a nasal cannula, which supports the concept that oxygen passively circulates through the glottis and into the alveoli. A paramedic... Read more..

The Difficult Airway Course Opens 2015 Schedule in Orlando

Airway Management Education Center is pleased to announce the first 2015 offering of The Difficult Airway CourseTM. Two intensive CME programs will be held in Orlando, Florida, March 6 - 8 at the Hyatt Grand Cypress.   The Difficult Airway Course: Emergency provides an immersion experience in difficult and failed airway management... Read more..

A Letter to Our Readers – A Farewell from Editor-in-Chief Ron Walls

Dear Readers,   Happy New Year! I hope you had a restful and memorable holiday, surrounded by loved ones. The New Year often brings change, and this year brings a very big change for me. On January 1, 2015, I began a new role as Executive Vice President and Chief Operating Officer... Read more.. 1 2