Extraglottic Airway Device Misplacement: A Novel Classification System and Findings in Postmortem Computed Tomography

Authors

Tatsuya Norii, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: tanorii@salud.unm.edu
Yohsuke Makino, Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kana Unuma, Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
Gary M. Hatch, Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM
Natalie L. Adolphi, Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Center for Forensic Imaging, University of New Mexico Health Sciences Center, Albuquerque, NM
Sarah Dallo, Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM
Danielle Albright, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
David P. Sklar, College of Health Solutions, Arizona State University, Phoenix, AZ
Darren Braude, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Anesthesiology, University of New Mexico Health Sciences Center, Albuquerque, NM

Document Type

Article

Publication Date

3-1-2021

Abstract

STUDY OBJECTIVE: Extraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ.

METHODS: We assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data. An expert panel developed a novel extraglottic airway device misplacement classification system. We then applied the schema in reviewing postmortem CT for extraglottic airway device position and potential complications.

RESULTS: We identified 341 eligible decedents. The median age was 47.0 years (interquartile range 32 to 59 years). Out-of-hospital personnel placed extraglottic airway devices in 265 patients (77.7%) who subsequently died out of hospital; the remainder died inhospital. The classification system consisted of 6 components: depth, size, rotation, device kinking, mechanical blockage of ventilation opening, and injury. Under the system, extraglottic airway devices were found to be misplaced in 49 cases (14.4%), including 5 (1.5%) that resulted in severe injuries.

CONCLUSION: We created a novel extraglottic airway device misplacement classification system. Misplacement occurred in greater than 14% of cases. Severe traumatic complications occurred rarely. Quality improvement activities should include review of extraglottic airway device placement when CT images are available and use the classification system to describe misplacements.

Recommended Citation

Norii T, Makino Y, Unuma K, Hatch GM, Adolphi NL, Dallo S, Albright D, Sklar DP, Braude D. Extraglottic Airway Device Misplacement: A Novel Classification System and Findings in Postmortem Computed Tomography. Ann Emerg Med. 2021 Mar;77(3):285-295. doi: 10.1016/j.annemergmed.2020.10.005. Epub 2021 Jan 15. PMID: 33455839.