| Airway Adjunct
|
Examples
|
Pros
|
Cons
|
| Endotracheal tube introducer |
Gum elastic bougie
|
- Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not[1]
- Can pass blind and confirm tracheal placement with tracheal clicks and hold-up sign
|
- Success rates likely depend on operator familiarity with device
|
| Lighted optical stylets |
|
- High success rate - especially good for trauma, c-spine precautions
- Use for both reg and nasotrach
- Lower complication rate
|
- Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
|
| Supraglottic airway |
LMA
|
- Easy to place
- Can be placed quickly
|
- Does not protect against aspiration
|
| Esophogeal obturator |
Combitube
|
- Good for nurses and paramedics with limited intubation skill
- Indicated if difficult airway predicted: cannot see glottis with laryngoscope
- Reduced risk for aspiration compared to face mask or LMA *Can maintain spinal immobilization
|
- Large size predisposes to esophogeal dilatation and laceration as a complication
|
| Percutaneous transtracheal ventilation
|
|
- Prefered over cricothyrotomy in children up to age 10-12
- Oxygenates well
- Can use for 30-45 min
|
- Can retain CO2
- May cause pneumothorax or barotrauma
|
