Contraindications for Airway Management

Airway management is a key pillar of emergency medicine. When performed correctly, it can save lives, improve surgical outcomes, and improve quality of life for terminally ill patients. However, airway management presents a number of complications and risks. Knowing the contraindications for airway management can help you better serve patients and reduce the risk of needless morbidity. 


Is Airway Management Ever 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 own 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. Organizations that train civilians in basic airway management should educate them about these contraindications. 


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. 


Supplemental oxygen may complicate some forms of congenital heart disease by dilating pulmonary vascular structures. Cricothyrotomy is generally contraindicated in children under the age of 5, though the specific age varies depending on the child’s anatomy and size. 


It’s important to note that even though many textbooks list these contraindications for airway management, 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 

Particularly 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, and 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

New Call-to-action