LEVEL: AEMT/Paramedic

This procedure may be performed on any patient in which attempts at basic airwayand ventilatory support are unsuccessful AND who has at least one of the following:
A.  Hypoxia
B.  Respiratory arrest/failure
C.  Obtundation
D.  Failed endotracheal intubation

A.  Gag reflex
B.  History of esophageal trauma, or known esophageal disease
C.  Recent ingestion of a caustic substance
D.  Tracheostomy or laryngectomy
E.  Suspected foreign body obstruction

Check and prepare the
extraglottic airway
device prior to insertion

Key procedural considerations:
A.  Pre-oxygenate the patient.
B.  Position the patient’s head in a neutral or slightly flexed position if no suspected spinal injury (if a spine injury is suspected, maintain a neutral, in-line head position).
C.  Perform a tongue-jaw lift.
D.  Insert device to proper depth. NEVER force. If device does not advance, readjust the insertion.
E.  Secure device in the patient (inflate cuff(s) with proper volume(s) and immediately remove syringe).
F.  Ventilate patient and confirm proper ventilation (correct lumen and proper insertion depth) by auscultation bilaterally over lungs and over epigastrium.
G.  Adjust ventilation as necessary (ventilate through additional lumen or slightly withdraw tube until ventilation is optimized).
H.  Verify proper tube placement by secondary confirmation such as capnography or colorimetric device.
I.  Secure device or confirm that the device remains properly secured.