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German guideline for prehospital airway management (short version)

Timmerman, Bottiger, Byhahn, Noppens et al. Anästh Intensivmed 2019;60:316-336

Summary

An expert panel of the German Society for Anaesthesiology and Intensive Care Medicine developed the Guideline, “Prehospital Airway Management.” This guideline addresses to paramedics and physicians in the pre-hospital setting. We used a structured analysis of rele­- vant publications reflecting the current evidence and made 39 recommendations according to the GRADE system, based on the Delphi method. The key recommendations of the new S1 Guideline include a critical indication check if a patient requires invasive airway management techniques. In patients with spontaneous breathing, an adequate pre-oxygenation is mandatory using the highest amount of inspiratory oxygen. Using a video laryngoscope with a Macintosh-style blade for endo­tracheal intubation (ETI) is the new standard of care; the use of Macintosh-style video laryngoscopes provides both direct and indirect laryngoscopy. We recommend that documented and supervised training (involving at least 100 ETIs and subsequently, 10 ETIs per year for elective patients) is applied before clinicians perform ETIs. A second-generation extraglottic airway (EGA) can be used if there is only a minor chance of a successful ETI; at least 45 initial EGA insertions, and subsequently three EGA insertions per year, must be performed and documented in elective patients before using this technique. In children, mask ventilation is the method of choice in the pre-hospital setting. We recommend using laryngeal masks as an EGA. Alternatively, pharyngeal ventilation may be applied using a pharyngeal-placed endotracheal tube. Clinicians must invariably make use of capnography when applying airway management techniques. Education in airway management must involve patient-based training, as we do not re- commend training on manikins alone. Airway management equipment used in the pre-hospital setting must be adapted to the clinical equipment used for training, especially regarding the type of EGA and video laryngoscopes.

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