Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management

Root, Christopher W.; Mitchell, Oscar; Brown, Russ; Evers, Christopher B.; Boyle, Jess; Griffin, C. J.; West, Frances Mae; Gomm, Edward; Miles, Edward; McGuire, Barry; Swaminathan, Anand; George, Jonathan St.; Horowitz, James; DuCanto, James

doi:10.1016/j.resplu.2020.100005

Cited by 22 publications

(20 citation statements)

References 25 publications

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Section: Discussion/observationsmentioning

confidence: 99%

“…During intubation, the catheter maintains continuous suction in the hypopharynx. [5,60] A bougie can be used to aid in intubation.…”

Section: Discussion/observationsmentioning

confidence: 99%

“…An technically proficient operator is fundamental. [60] Optimal cardiopulmonary resuscitation is associated with better outcomes. Therefore, an effective early airway management is essential.…”

Section: Emergency Airway Management Outside Of the Operating Roommentioning

confidence: 99%

“…The SALAD technique may be considered in a clinical setting such as regurgitation of gastric contents, copious secretions, post-operative upper airway bleeding and upper gastrointestinal hemorrhage. [60] It has also been used outside the operating room, in cases of upper airway hemorrhage or trauma. [5] The rigid suction catheter is inserted into the mouth and swept side to side; then it is used to displace the structures of the upper airway (tongue elevation) until the blade of the laryngoscope has been optimally positioned.…”

Section: Emergency Airway Management Outside Of the Operating Roommentioning

confidence: 99%

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New technologies in airway management: A review

et al. 2022

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The evolution of medical knowledge and technological growth have contributed to the development of different techniques and devices for airway management. These appear to play a role in optimizing the number of attempts and overall success, ultimately reducing the negative consequences of airway manipulation. In this literature review, we highlight the recent evidence regarding new technologies applied to airway management. Before intubation, every patient should have an individualized structured airway management plan. Technology can help with both airway evaluation and tracheal intubation. Point-of-care cervical ultrasound and artificial intelligence models with automated facial analysis have been used to predict difficult airways. Various devices can be used in airway management. This includes a robotic video endoscope that guides intubation based on real image recognition, a laryngeal mask with a non-inflatable cuff that tries to reduce local complications, video laryngeal masks that are able to confirm the correct position and facilitate intubation, Viescope™, a videolaryngoscope developed for combat medicine with a unique circular blade, a system that uses cervical transillumination for glottis identification in difficult airways and Vivasight SL™ tracheal tube, which has a high-resolution camera at its tip guaranteeing visual assurance of tube position as well as guiding bronchial blocker position. To conclude, we detailed the challenges in airway management outside the operating room as well as described suction-assisted laryngoscopy and airway decontamination technique for contaminated airways. Further research in the clinical setting is recommended to better support the use of these technologies

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Section: Discussion/observationsmentioning

confidence: 99%

“…During intubation, the catheter maintains continuous suction in the hypopharynx. [5,60] A bougie can be used to aid in intubation.…”

Section: Discussion/observationsmentioning

confidence: 99%

Section: Emergency Airway Management Outside Of the Operating Roommentioning

confidence: 99%

Section: Emergency Airway Management Outside Of the Operating Roommentioning

confidence: 99%

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New technologies in airway management: A review

et al. 2022

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“…Suction-assisted laryngoscopy and airway decontamination (SALAD) technique, developed by DuCanto et al, is a method of active drainage of airway contaminants during intubation [ 25 , 26 ]. The main steps of the SALAD technique are the hypopharyngeal withdrawal and reinsertion of a large-bore rigid suction catheter to the left of the laryngoscope for active and continued drainage of blood or regurgitated gastric contents after initial suctioning the mouth.…”

Section: Discussionmentioning

confidence: 99%

Compromised cardiopulmonary resuscitation quality due to regurgitation during endotracheal intubation: a randomised crossover manikin simulation study

et al. 2022

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Background Regurgitation is a complication common during cardiopulmonary resuscitation (CPR). This manikin study evaluated the effect of regurgitation during endotracheal intubation on CPR quality. Methods An airway-CPR manikin was modified to regurgitate simulated gastric contents into the oropharynx during chest compression during CPR. In total, 54 emergency medical technician-paramedics were assigned to either an oropharyngeal regurgitation or clean airway scenario and then switched to the other scenario after finishing the first. The primary outcomes were CPR quality metrics, including chest compression fraction (CCF), chest compression depth, chest compression rate, and longest interruption time. The secondary outcomes were intubation success rate and intubation time. Results During the first CPR–intubation sequence, the oropharyngeal regurgitation scenario was associated with a significantly lower CCF (79.6% vs. 85.1%, P < 0.001), compression depth (5.2 vs. 5.4 cm, P < 0.001), and first-pass success rate (35.2% vs. 79.6%, P < 0.001) and greater longest interruption duration (4.0 vs. 3.0 s, P < 0.001) than the clean airway scenario. During the second and third sequences, no significant difference was observed in the CPR quality metrics between the two scenarios. In the oropharyngeal regurgitation scenario, successful intubation was independently and significantly associated with compression depth (hazard ratio = 0.47, 95% confidence interval, 0.24–0.91), whereas none of the CPR quality metrics were related to successful intubation in the clean airway scenario. Conclusion Regurgitation during endotracheal intubation significantly reduces CPR quality. Trial registration ClinicalTrials.gov, NCT05278923, March 14, 2022.

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Modified cadaver technique to simulate contaminated airway scenarios to train medical providers in suction‐assisted laryngoscopy and airway decontamination

Chadason,

Root,

Boyle

et al. 2024

AEM Education and Training

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Simulation training plays a vital role in modern medical education, fostering safe skill development. Task‐trainer manikin and cadaveric airway management training (CAMT) offer realistic airway management practice. Simulation allows learners the opportunity to manage high‐risk, low‐frequency scenarios, including difficult airways and massive airway contamination, common in emergent airway management. The suction‐assisted laryngoscopy and airway decontamination (SALAD) technique was developed to address massive airway contamination. This paper describes two methods to simulate massive airway contamination utilizing cadavers. We detail our techniques for both esophageal and nasopharyngeal delivery of simulated airway contaminant. Nasopharyngeal delivery was less invasive and required less time to set up. Utilizing cadavers to simulate massive airway contamination in CAMT provides learners with tools to manage airway complications effectively, enhancing readiness for complex airway challenges while promoting patient safety in clinical practice.

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Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management

Cited by 22 publications

References 25 publications

New technologies in airway management: A review

New technologies in airway management: A review

Compromised cardiopulmonary resuscitation quality due to regurgitation during endotracheal intubation: a randomised crossover manikin simulation study

Modified cadaver technique to simulate contaminated airway scenarios to train medical providers in suction‐assisted laryngoscopy and airway decontamination

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