Managing and securing the bleeding upper airway: a narrative review

Michael Seltz Kristensen (Lead / Corresponding author), Barry McGuire

    Research output: Contribution to journalReview articlepeer-review

    21 Citations (Scopus)


    Failure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. We identified techniques that establish a definitive airway, even in cases of impeded visibility resulting from severe bleeding in the airway. These include flexible video-/optical- scope-guided intubation via a supraglottic airway device; cricothyroidotomy or tracheotomy; and retrograde-, blind nasal-, oral-digital-, light-, and ultrasound-guided intubation. We provide a structured approach to managing bleeding in the airway that accounts for the source of bleeding and the estimated risk of failure to intubate using direct laryngoscopy or to achieve a front-of-neck access for surgical airway rescue. In situations where these techniques are predicted to be successful, the recommended approach is to identify the cricothyroid membrane (in preparation for rescue cricothyroidotomy), followed by rapid sequence induction. In situations where traditional management of the airway is likely to fail, we recommend an awake approach with one of the aforementioned techniques.

    Original languageEnglish
    Pages (from-to)128-140
    Number of pages13
    JournalCanadian Journal of Anesthesia
    Issue number1
    Early online date23 Sept 2019
    Publication statusPublished - 1 Jan 2020

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine


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