Airway management is a key pillar of emergency medicine. When performed correctly, it can save lives, improve surgical outcomes, and improve the quality of life for terminally ill patients. However, airway management presents complications and risks. Knowing the contraindications for airway management can help you better serve patients and reduce the risk of needless morbidity.
When Airway Management is Contraindicated
There are only two absolute contraindications to airway management:
- A competent legal adult who declines airway management after learning of the risks and benefits
- A patient with a do-not-resuscitate (DNR) order that requests no airway management, or that prohibits certain forms of airway management.
First responders and medical providers must honor patient wishes according to the laws in their state. They cannot substitute their wishes and judgment for the clearly stated desires of the patient.
There are no broad medical contraindications that prohibit all forms of airway management. Instead, first responders must ask questions about a patient’s history, gather data about their wishes and concerns, and select the right airway management strategy according to this information.
Basic Airway Management Contraindications
Basic airway management requires little training, and there are few contraindications. The primary concern with basic airway management is that it may require moving a patient or adjusting their head using the chin-lift maneuver.
In patients with spinal cord injuries and some other traumatic injuries, any form of movement can be life-threatening. Other contraindications include severe airway trauma or an obstruction that does not permit safe placement of an endotracheal tube.
Advanced Airway Management Contraindications
Although there are no contraindications that weigh against all forms of advanced airway management, every airway management strategy has some contraindications. For example, some contraindications to suctioning include:
- Bleeding disorder
- Bronchospasm
- Facial injury or basal skull fracture
- Severe hemodynamic instability
- Tracheal fistula
Certain conditions may contraindicate some forms of suction, but not others. For example, croup and epiglottitis can make nasotracheal suctioning unsafe, though they may not prohibit other types of suctioning. Facial fractures and apnea or respiratory rest may render nasal intubation unsafe.
It’s important to note that even though many textbooks list these contraindications, there is no absolute contraindication to airway management.
The risk of various interventions is real, but the risk of doing nothing is much greater. So medical providers and first responders must always undertake a risk assessment when deciding which form of airway management is best. When there are no good options, you may need to choose a contraindicated procedure to save the patient’s life.
How the Right Equipment Helps
When a patient has certain contraindications for suctioning and other airway management strategies, choosing the right equipment can mitigate risk. For example, if a patient has a short thyromental distance or shows signs of a difficult airway, using smaller equipment may reduce the risk of airway trauma.
Using the right equipment requires having the right equipment clean and ready to go, so keeping your supplies in an accessible location may make the difference between a rapid response and significant treatment delays.
Portable emergency suction allows you to quickly treat patients wherever they are. The right machine delivers consistent, reliable suction, reducing the risks of failed suctioning. To find the right choice for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally published in March 2020. It has been re-published with additional up to date content.
