Airway management in emergency medicine. Presentation of the S1 guidelines on airway management of the German Society of Anaesthesiology and Intensive Care Medicine and further recommendations on preclinical airway management

The S1 guidelines on airway management of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) gives recommendations on the use of various techniques for securing the airway and on strategies in the case of difficult airway management. This article presents the recommendations relevant to emergency medicine, complemented by aspects from the practical recommendations on preclinical airway management of the DGAI and the guidelines on prehospital airway management of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). Endotracheal intubation (ETI) remains the method of choice to secure the airway in emergency medicine but requires sufficient training. Bag mask ventilation and extraglottic airway (EGA) devices are alternative methods. The EGAs should be equipped with a gastric drainage channel and the cuff pressure should be measured. Cricothyroidotomy is a salvage technique in cases of imminent asphyxia. Before induction of anaesthesia the patient needs to be examined for predictors of difficult airway management and preoxygenated. In case of difficult intubation, attempts at intubation should be limited to two and techniques should be optimized, e.g. by positioning head and larynx, using a bougie or video laryngoscopy. If these attempts fail, alternative methods, including cricothyroidotomy if necessary, should be resorted to.