Airway management has and will always be a priorityin resuscitation efforts. The ‘‘ABCs’’ of resuscitationare in part an acronym of convenience meant toremind us to focus our management priorities.Traditionally, these priorities have included earlyendotracheal intubation and success was measured inpart by completion of this procedure. Improved airwaymanagement patient outcomes depend on successfulmaintenance of physiologic parameters (oxygenationand hemodynamic status), not on placement of apolyvinyl endotracheal tube (ETT) alone. The prehospital world has served as a reminder that duringresuscitation, we may have become too intubationfocused, at the cost of the physiologic priority ofoxygenation.1–4 This evidence does not mean that directlaryngoscopy (DL) and intubation were a cause ofharm but that physiologic goals must supersede tubeplacement as a desired end point. Before equating ‘‘A’’with intubation, it is important to consider thefollowing: Is it a ‘‘crash’’ situation, where airwaycontrol needs to be done immediately? Does thepatient have difficult airway features? How experiencedis the clinician poised to perform the procedure? Ishelp nearby? Answers to these key questions are morelikely to positively influence outcome than any decisionsurrounding which airway device to use.
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