Sammendrag
Background: The Scandinavian society of anaesthesiology and inten-
sive care medicine task force on pre-hospital airway management was
asked to formulate recommendations following standards for trustworthy
clinical practice guidelines.
Methods: The literature was systematically reviewed and the grading
of recommendations assessment, development and evaluation (GRADE)
system was applied to move from evidence to recommendations.
Results: We recommend that all emergency medical service (EMS) pro-
viders consider to: apply basic airway manoeuvres and airway adjuncts
(good practice recommendation); turn unconscious non-trauma patients
into the recovery position when advanced airway management is unavail-
able (good practice recommendation); turn unconscious trauma patients to
the lateral trauma position while maintaining spinal alignment when
advanced airway management is unavailable [strong recommendation, low
quality of evidence (QoE)]. We suggest that intermediately trained provi-
ders use a supraglottic airway device (SAD) or basic airway manoeuvres on
patients in cardiac arrest (weak recommendation, low QoE). We recom-
mend that advanced trained providers consider using an SAD in selected
indications or as a rescue device after failed endotracheal intubation (ETI)
(good practice recommendation). We recommend that ETI should only be
performed by advanced trained providers (strong recommendation, low
QoE). We suggest that videolaryngoscopy is considered for ETI when
direct laryngoscopy fails or is expected to be difficult (weak recommenda-
tion, low QoE). We suggest that advanced trained providers apply cricothy-
roidotomy in ‘cannot intubate, cannot ventilate’ situations (weak
recommendation, low QoE).
Conclusion: This guideline for pre-hospital airway management
includes a combination of techniques applied in a stepwise fashion
appropriate to patient clinical status and provider training.
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