Airway management in prehospital emergency medicine

Securing and monitoring the airways in emergency patients are among the key requirements of appropriate prehospital therapy. For spontaneously breathing patients, the indication for airway management and prehospital anaesthesia should be checked carefully. For example, non-invasive techniques that facilitate respiratory work and improve oxygenation can be used in various diseases. Since the patient is unconscious and apnoeic bag-mask ventilation should be attempted until other techniques are available. Endotracheal intubation is still the so-called "gold standard" for airway management in a prehospital setting. Video laryngoscopes have an increasing role. However, none of the currently available devices is universally applicable in every situation. In addition, the use of a video laryngoscope requires sufficient experience with this technique. To achieve a high first-pass-success, Macintosh-like blades should be routinely used and strongly curved blades should be available for special situations only. Extraglottic airways devices (EGA) are an alternative to mask ventilation and endotracheal intubation. They can be used primarily if the user does not have sufficient expe-rience in endotracheal intubation or as an alternative to failed intubation. EGA with the possibility of gastric drainage should be preferred. After successful placement, the cuff pressure should be measured and adjusted. Cricothyrotomy is the last technique for preventing a patient from severe hypoxia. It is required when oxygenation and ventilation cannot be achieved by other techniques ("cannot intubate, cannot ventilate").