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CT imaging of extraglottic airway device—pictorial review

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Abstract

Compared to intubation with a cuffed endotracheal tube, extraglottic airway devices (EGDs), such as laryngeal mask airways, are considered less definitive ventilation conduit devices and are therefore often exchanged via endotracheal intubation (ETI) prior to obtaining CT images. With more widespread use and growing comfort among providers, reports have now described use of EGDs for up to 24 h including cases for which clinicians obtained CT scans with an EGD in situ. The term EGD encompasses a wide variety of devices with more complex structure and CT appearance compared to ETI. All EGDs are typically placed without direct visualization and require less training and time for insertion compared to ETI. While blind insertion generally results in functional positioning, numerous studies have reported misplacements of EGDs identified by CT in the emergency department or post-mortem. A CT-based classification system has recently been suggested to categorize these misplacements in six dimensions: depth, size, rotation, device kinking, mechanical blockage of the ventilation opening(s), and injury from EGD placement. Identifying the type of EGD and its correct placement is critically important both to provide prompt feedback to clinicians and prevent inappropriate medicolegal problems. In this review, we introduce the main types of EGDs, demonstrate their appearance on CT images, and describe examples of misplacements.

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References

  1. Donatelli J, Gupta A, Santhosh R, Hazelton TR, Nallamshetty L, Macias A, Rojas CA (2015) To breathe or not to breathe: a review of artificial airway placement and related complications. Emerg Radiol 22(2):171–179. https://doi.org/10.1007/s10140-014-1271-8

    Article  PubMed  Google Scholar 

  2. Norii T, Makino Y, Unuma K, Hatch GM, Adolphi NL, Dallo S, Albright D, Sklar DP, Braude D. (2021) Extraglottic airway device misplacement: a novel classification system and findings in postmortem computed tomography. Ann Emerg Med 15:S0196-0644(20)31266-X. https://doi.org/10.1016/j.annemergmed.2020.10.005

  3. Green DB, Root CW, Drexler IR, Legasto AC, St George J (2017) The King laryngeal tube: a mimic of esophageal intubation in the emergency department. Emerg Radiol 24(6):701–704. https://doi.org/10.1007/s10140-017-1529-z

    Article  PubMed  Google Scholar 

  4. Driver BE, Plummer D, Heegaard W, Reardon RF (2016) Tracheal malplacement of the King LT airway may be an important cause of prehospital device failure. J Emerg Med 51(6):e133–e135. https://doi.org/10.1016/j.jemermed.2016.07.006

    Article  PubMed  Google Scholar 

  5. White JM, Braude DA, Lorenzo G, Hart BL (2015) Radiographic evaluation of carotid artery compression in patients with extraglottic airway devices in place. Acad Emerg Med 22(5):636–638. https://doi.org/10.1111/acem.12647

    Article  PubMed  Google Scholar 

  6. Braude D, Steuerwald M, Wray T, Galgon R (2019) Managing the out-of-hospital extraglottic airway device. Ann Emerg Med 74(3):416–422. https://doi.org/10.1016/j.annemergmed.2019.03.002

    Article  PubMed  Google Scholar 

  7. Braude D, Southard A, Bajema T, Sims E, Martinez J (2010) Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation. 81(9):1217. https://doi.org/10.1016/j.resuscitation.2010.06.001

    Article  PubMed  Google Scholar 

  8. Schweitzer W, Spycher I, Winklhofer S, Thali MJ, Ruder TD, Ampanozi G, Flach PM, Ross SG (2013) Assessment of laryngeal tube placement on post mortem computed tomography scans. J Forens Radiol Imag 1(3):119–123

    Article  Google Scholar 

  9. Hernandez MR, Klock PA Jr, Ovassapian A (2012) Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg 114(2):349–368. https://doi.org/10.1213/ANE.0b013e31823b6748

    Article  PubMed  Google Scholar 

  10. Portereiko JV, Perez MM, Hojman H, Frankel HL, Rabinovici R (2006) Acute upper airway obstruction by an over-inflated Combitube esophageal obturator balloon. J Trauma 60(2):426–427. https://doi.org/10.1097/01.ta.0000203539.79009.50

    Article  PubMed  Google Scholar 

  11. Steenburg SD, Spitzer T, Rhodes A (2019) Post-mortem computed tomography improves completeness of the trauma registry: a single institution experience. Emerg Radiol 26(1):5–13. https://doi.org/10.1007/s10140-018-1637-4

    Article  PubMed  Google Scholar 

  12. Cook TM, Kelly FE (2015) Time to abandon the ‘vintage’ laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth 115(4):497–499. https://doi.org/10.1093/bja/aev156

    Article  CAS  PubMed  Google Scholar 

  13. Timmermann A, Bergner UA, Russo SG (2015) Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways. Curr Opin Anaesthesiol 28(6):717–726. https://doi.org/10.1097/ACO.0000000000000262

    Article  PubMed  Google Scholar 

  14. Rabitsch W, Schellongowski P, Staudinger T, Hofbauer R, Dufek V, Eder B, Raab H, Thell R, Schuster E, Frass M (2003) Comparison of a conventional tracheal airway with the Combitube in an urban emergency medical services system run by physicians. Resuscitation. 57(1):27–32. https://doi.org/10.1016/s0300-9572(02)00435-5

    Article  PubMed  Google Scholar 

  15. Van Zundert AA, Kumar CM, Van Zundert TC (2016) Malpositioning of supraglottic airway devices: preventive and corrective strategies. Br J Anaesth 116(5):579–582. https://doi.org/10.1093/bja/aew104

    Article  PubMed  Google Scholar 

  16. Vannucci A, Rossi IT, Prifti K, Kallogjeri D, Rangrass G, DeCresce D, Brenner D, Lakshman N, Helsten DL, Cavallone LF (2018) Modifiable and nonmodifiable factors associated with perioperative failure of extraglottic airway devices. Anesth Analg 126(6):1959–1967. https://doi.org/10.1213/ANE.0000000000002659

    Article  PubMed  Google Scholar 

  17. Vithalani VD, Vlk S, Davis SQ, Richmond NJ (2017) Unrecognized failed airway management using a supraglottic airway device. Resuscitation. 119:1–4. https://doi.org/10.1016/j.resuscitation.2017.07.019

    Article  PubMed  Google Scholar 

  18. Driver BE, Plummer D, Heegaard W, Reardon RF (2016) Tracheal malplacement of the King LT airway may be an important cause of prehospital device failure. J Emerg Med 51(6):e133–e135. https://doi.org/10.1016/j.jemermed.2016.07.006

    Article  PubMed  Google Scholar 

  19. Nagata S, Kim SH, Mizushima Y, Norii T (2018) Airway obstruction due to sticky rice cake (mochi): a case series and review of the literature. Int J Emerg Med 11(1):34. Published 2018 Aug 22. https://doi.org/10.1186/s12245-018-0194-7

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vézina MC, Trépanier CA, Nicole PC, Lessard MR (2007) Complications associated with the Esophageal-Tracheal Combitube in the pre-hospital setting. Can J Anaesth 54(2):124–128. https://doi.org/10.1007/bf03022008

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency Medicine, University of New Mexico Health Sciences Center, MSC11 6025 Lomas Blvd NE, Albuquerque, NM, 87131-0001, USA

    Tatsuya Norii, Danielle Albright, Cameron Crandall & Darren Braude

  2. Department of Forensic Medicine, The University of Tokyo, Tokyo, Japan

    Yohsuke Makino

  3. Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Kana Unuma

  4. Center for Forensic Imaging, Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Natalie L. Adolphi

  5. College of Health Solutions, Arizona State University, Phoenix, AZ, USA

    David P. Sklar

  6. Department of Anesthesiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Darren Braude

Authors
  1. Tatsuya Norii
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  2. Yohsuke Makino
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  3. Kana Unuma
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  4. Natalie L. Adolphi
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  5. Danielle Albright
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  6. David P. Sklar
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  7. Cameron Crandall
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  8. Darren Braude
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Correspondence to Tatsuya Norii.

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Norii, T., Makino, Y., Unuma, K. et al. CT imaging of extraglottic airway device—pictorial review. Emerg Radiol 28, 665–673 (2021). https://doi.org/10.1007/s10140-021-01909-2

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  • DOI: https://doi.org/10.1007/s10140-021-01909-2

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