Pre-hospital airway management is an essential skill for every pre-hospital clinician and should be performed to the same standards as would be expected in the emergency department. This chapter recommends tailored pre-hospital airway management in terms of clinical care delivered to the patient, skills of the clinician and the infrastructure of emergency medical system to achieve this. The importance of having a standardised, well-rehearsed approach, using aids to reduce cognitive load, articulating a clear airway management plan and having a structured way of handling airway management difficulties is highlighted. The concept of the physiologically difficult airway is discussed and the significance of excellent pre-oxygenation, peroxygenation, first-pass success and post-intubation care is discussed. Backup equipment in the form of second generation supraglottic airway devices, a videolaryngoscope with both standard and hyperangulated blades and equipment for an emergency front of neck airway should be available when advanced pre-hospital airway management is provided. When delivering airway management to trauma patients, an awareness of potential anatomical difficulties combined with careful management of physiological derangement is necessary to deliver safe, high quality care.

Supraglottic airways (SGAs) have been part of core anaesthetic practice for approximately 30 years, since the introduction of the classic laryngeal mask which is described in some detail. In many countries an SGA is now used for airway management for the majority of anaesthetics. Optimal use and insertion technique are described. The range of SGAs available and their roles have expanded dramatically in this time. Second generation SGAs are those designed to reduce the risk of aspiration and are emphasised in this chapter. With the wide range of SGAs available it can be problematic to decide which device to use and this is especially so as the boundaries of acceptable use are ever widened. This chapter describes those devices with the greatest versatility and utility – arguably also with the greatest safety profile too – and some newer devices. SGAs have a major role to play in advanced and difficult airway management. The use of an SGA as a rescue device and as a conduit for intubation during management of the difficult airway is described in detail.