Radiographic evaluation of carotid artery compression in patients with extraglottic airway devices in place

Acad Emerg Med. 2015 May;22(5):636-8. doi: 10.1111/acem.12647. Epub 2015 Apr 22.


Objectives: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-of-hospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs.

Methods: The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present.

Results: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery.

Conclusions: Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.

MeSH terms

  • Adult
  • Airway Management / adverse effects
  • Airway Management / instrumentation*
  • Cardiopulmonary Resuscitation / adverse effects
  • Cardiopulmonary Resuscitation / instrumentation*
  • Carotid Arteries / diagnostic imaging*
  • Carotid Arteries / pathology
  • Cerebrovascular Circulation / physiology
  • Emergency Medical Services / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Regional Blood Flow
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / instrumentation*
  • Risk Assessment
  • Safety Management