Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Abstract

Objectives: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-ofhospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. Methods:The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present.Results: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery. Conclusions:Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.ACADEMIC EMERGENCY MEDICINE 2015;22:636-638 © 2015 by the Society for Academic Emergency Medicine E xtraglottic airway devices (EADs) are commonly placed by emergency medical services (EMS) providers for airway management of critically ill or injured patients in the prehospital setting, and less commonly by physicians in the emergency department (ED). 1 Most EADs use an inflatable cuff in the hypopharynx to prevent airflow into the esophagus and to direct airflow into the trachea and lungs (see Figure 1). There exists a theoretical concern that the inflated cuffs on these devices may cause compression of the arteries in the neck that supply the brain. A recent study by Segal et al. 2 found a decrease in cerebral blood flow when EADs were used in a swine model. Colbert et al. 3 demonstrated that the laryngeal mask airway (LMA) cuff had an effect on the carotid bulb cross-sectional area and blood flow. Nandwani et al. 4 noted no sonographically evident displacement or compression of the internal jugular vein and the carotid artery in human subjects when an LMA was placed. In this study, we took advantage of a common practice at our institution in which well-functioning EADs placed in the field are left in situ for initial resuscitation and imaging in the ED. As a result, we have a number of patients who have undergone cross-sectional computed tomography (CT) studies of the cervical spine with various EADs in place. We examined whether or not mechanical carotid artery compression presumed to be secondary to the presence of the air-filled cuff in the hypopharynx was present in patients who underwent neck imaging studies and had EADs in place. We hypothesized that carotid artery compression would not be identified. METHODS Study DesignThis was a retrospective study of images acquired during usual care in our ED. This study received an exemption from our institutional review board.

Laryngeal mask ventilation with chest compression during neonatal resuscitation: randomized, non-inferiority trial in lambs

“… 36 , 37 However, a study that evaluated carotid artery compression in patients with SGD did not demonstrate radiographically evident mechanical compression of the carotid artery. 38 Hemodynamic data from our study supports this observation. We did not find any significant difference in the carotid blood flow during or after resuscitation.…”

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

“…A pig study raised concerns that a supraglottic cuff compresses the internal and external carotid artery, decreasing cerebral blood flow during CPR. A human radiographic study did not, however, observe any evidence of mechanical compression of the carotid arteries [ 21 , 22 ].…”