TY - JOUR
T1 - Prehospital Drug Assisted Airway Management
T2 - An NAEMSP Position Statement and Resource Document
AU - Jarvis, Jeffrey L.
AU - Lyng, John W.
AU - Miller, Brian L.
AU - Perlmutter, Michael C.
AU - Abraham, Heidi
AU - Sahni, Ritu
N1 - Publisher Copyright:
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2022
Y1 - 2022
N2 - Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. NAEMSP recommends: DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight. DAAM should not be used in settings without adequate resources. EMS physicians should develop clinical guidelines informed by evidence and oversee the training and credentialing for safe and effective DAAM. DAAM programs should include best practices of airway management including patient selection, assessmenct and positioning, preoxygenation strategies including apneic oxygenation, monitoring and management of physiologic abnormalities, selection of medications, post-intubation analgesia and sedation, equipment selection, airway confirmation and monitoring, and rescue airway techniques. Post-DAAM airway placement must be confirmed and continually monitored with waveform capnography. EMS clinicians must have the necessary equipment and training to manage patients with failed DAAM, including bag mask ventilation, supraglottic airway devices and surgical airway approaches. Continuous quality improvement for DAAM must include assessment of individual and aggregate performance metrics. Where available for review, continuous physiologic recordings (vital signs, pulse oximetry, and capnography), audio and video recordings, and assessment of patient outcomes should be part of DAAM continuous quality improvement.
AB - Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. NAEMSP recommends: DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight. DAAM should not be used in settings without adequate resources. EMS physicians should develop clinical guidelines informed by evidence and oversee the training and credentialing for safe and effective DAAM. DAAM programs should include best practices of airway management including patient selection, assessmenct and positioning, preoxygenation strategies including apneic oxygenation, monitoring and management of physiologic abnormalities, selection of medications, post-intubation analgesia and sedation, equipment selection, airway confirmation and monitoring, and rescue airway techniques. Post-DAAM airway placement must be confirmed and continually monitored with waveform capnography. EMS clinicians must have the necessary equipment and training to manage patients with failed DAAM, including bag mask ventilation, supraglottic airway devices and surgical airway approaches. Continuous quality improvement for DAAM must include assessment of individual and aggregate performance metrics. Where available for review, continuous physiologic recordings (vital signs, pulse oximetry, and capnography), audio and video recordings, and assessment of patient outcomes should be part of DAAM continuous quality improvement.
KW - airway management
KW - apneic oxygenation
KW - capnography
KW - delayed sequence airway
KW - out-of-hospital
KW - prehospital
KW - rapid sequence airway
KW - rapid sequence intubation
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U2 - 10.1080/10903127.2021.1990447
DO - 10.1080/10903127.2021.1990447
M3 - Article
C2 - 35001829
AN - SCOPUS:85122746254
SN - 1090-3127
VL - 26
SP - 42
EP - 53
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - S1
ER -