Airway Management in Acutely Neurologically Compromised Patients: A Narrative Review of Evidence-Based Strategies in Emergency Care

Authors

DOI:

https://doi.org/10.71112/3rxe2342

Keywords:

Intubation, Neurology, Emergency, Hypoxia, Lidocaine, Seizures, Trauma

Abstract

In Emergency and Critical Care settings, maintaining the airway in neurologically deteriorating patients is of vital importance.

This article aims to provide an up-to-date analysis of airway assessment and management in cases of altered consciousness, considering the underlying pathophysiological challenges as well as the recommended pharmacological and technical strategies.

The discussion includes criteria for early intubation, the selection of induction agents based on neurological status, and the impact of hypoxemic and hypercapnic events on neurological outcomes.

The objective is to critically examine recent literature and evidence to identify practical interventions that can guide treatment during acute episodes, particularly supporting the safe and appropriate airway management of neurologically impaired and deteriorating patients.

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References

Anderson, J., Ebeid, A., & Stallwood-Hall, C. (2022). Pre-hospital tracheal intubation in severe traumatic brain injury: A systematic review and meta-analysis. British Journal of Anaesthesia, 129(6), 977–984. https://doi.org/10.1016/j.bja.2022.07.033 DOI: https://doi.org/10.1016/j.bja.2022.07.033

Bunya, N., Hirofumi, O., Igarashi, Y., Norii, T., Katayama, Y., Kasai, T., Sawamoto, K., & Narimatsu, E. (2023). Effect of prehospital advanced airway management on out‐of‐hospital cardiac arrest due to asphyxia: A JAAM‐OHCA registry‐based observational study in Japan. Acute Medicine & Surgery, 10(1). https://doi.org/10.1002/ams2.912 DOI: https://doi.org/10.1002/ams2.912

Cho, N. J., Park, S., Lyu, J., Lee, H., Hong, M., Lee, E. Y., & Gil, H. W. (2022). Prediction model of acute respiratory failure in patients with acute pesticide poisoning by intentional ingestion: Prediction of respiratory failure in pesticide intoxication (PREP) scores in cohort study. Journal of Clinical Medicine, 11(4). https://doi.org/10.3390/jcm11041048 DOI: https://doi.org/10.3390/jcm11041048

Conzelmann, M., Hoidis, A., Bruckner, T., Popp, E., & Koschny, R. (2021). Aspiration risk in relation to Glasgow Coma Scale score and clinical parameters in patients with severe acute alcohol intoxication: A single-centre, retrospective study. BMJ Open, 11(10). https://doi.org/10.1136/bmjopen-2021-053619 DOI: https://doi.org/10.1136/bmjopen-2021-053619

Dharanindra, M., Jedge, P. P., Patil, V. C., Kulkarni, S. S., Shah, J., Iyer, S., & Dhanasekaran, K. S. (2023). Endotracheal intubation with King Vision video laryngoscope vs Macintosh direct laryngoscope in ICU: A comparative evaluation of performance and outcomes. Indian Journal of Critical Care Medicine, 27(2), 101–106. https://doi.org/10.5005/jp-journals-10071-24398 DOI: https://doi.org/10.5005/jp-journals-10071-24398

Filippelli, O. S. G., Giglio, A. M., Tiburzi, S. P., Archinà, M. T., Barozzi, E., Maglio, P., Candido, S., Viotti, R., Riccelli, U., Pezzi, M., Romano, C., Scozzafava, A. M., & Guzzo, M. L. (2021). Management of airways through rapid tracheostomy in a severely burnt patient attended to via helicopter. Case Reports in Emergency Medicine, 2021, 1–3. https://doi.org/10.1155/2021/5590275 DOI: https://doi.org/10.1155/2021/5590275

Flores Valdez, J. E., Martínez, L. C., Arias, J. C., & Peña, S. (2021). Manejo de la vía aérea mediante intubación submental en fracturas maxilofaciales. Alerta: Revista científica del Instituto Nacional de Salud, 4(3), 103–108. https://doi.org/10.5377/alerta.v4i3.11276 DOI: https://doi.org/10.5377/alerta.v4i3.11276

George, N., Consunji, G., Storkersen, J., Dong, F., Archambeau, B., Vara, R., Serrano, J., Hajjafar, R., Tran, L., & Neeki, M. M. (2022). Comparison of emergency airway management techniques in the performance of emergent cricothyrotomy. International Journal of Emergency Medicine, 15(1). https://doi.org/10.1186/s12245-022-00427-3 DOI: https://doi.org/10.1186/s12245-022-00427-3

González Balenciaga, M., & Balenciaga Traumatismo, G. M. (2020). Traumatismo craneal. Sociedad Española de Urgencias de Pediatría, 233–245. http://www.aeped.es/protocolos/

Hawkins, R. B., Raymond, S. L., Hamann, H. C., Taylor, J. A., Mustafa, M. M., Islam, S., & Larson, S. D. (2020). Outcomes after prehospital endotracheal intubation in suburban/rural pediatric trauma. Journal of Surgical Research, 249, 138–144. https://doi.org/10.1016/j.jss.2019.11.034 DOI: https://doi.org/10.1016/j.jss.2019.11.034

Hawryluk, G. W. J., Lulla, A., Bell, R., Jagoda, A., Mangat, H. S., Bobrow, B. J., & Ghajar, J. (2023a). Guidelines for prehospital management of traumatic brain injury 3rd edition: Executive summary. Neurosurgery, 93(6), E159–E169. https://doi.org/10.1227/neu.0000000000002672

Hawryluk, G. W. J., Lulla, A., Bell, R., Jagoda, A., Mangat, H. S., Bobrow, B. J., & Ghajar, J. (2023b). Guidelines for prehospital management of traumatic brain injury 3rd edition: Executive summary. Neurosurgery, 93(6), E159–E169. https://doi.org/10.1227/neu.0000000000002672 DOI: https://doi.org/10.1227/neu.0000000000002672

Hubbard, M. E., Pena, I., Freeman, D., & Tummala, R. P. (2020). Neurosurgeons performing tracheostomies – Maintaining proficiency in the modern era. Clinical Neurology and Neurosurgery, 192. https://doi.org/10.1016/j.clineuro.2020.105681 DOI: https://doi.org/10.1016/j.clineuro.2020.105681

Jain, U., McCunn, M., Smith, C. E., & Pittet, J. F. (2016). Management of the traumatized airway. Anesthesiology, 124(1), 199–206. https://doi.org/10.1097/ALN.0000000000000903 DOI: https://doi.org/10.1097/ALN.0000000000000903

Javaid, H., Shafique, S., Ajay, K., Zubair, F., & Sultan, S. F. (2021). Challenges in the endotracheal intubation of a patient with severe spine curvature abnormality. Cureus. https://doi.org/10.7759/cureus.18161 DOI: https://doi.org/10.7759/cureus.18161

Jung, J. Y. (2015a). Airway management of patients with traumatic brain injury/C-spine injury. Korean Journal of Anesthesiology, 68(3), 213–219. https://doi.org/10.4097/kjae.2015.68.3.213

Jung, J. Y. (2015b). Airway management of patients with traumatic brain injury/C-spine injury. Korean Journal of Anesthesiology, 68(3), 213–219. https://doi.org/10.4097/kjae.2015.68.3.213 DOI: https://doi.org/10.4097/kjae.2015.68.3.213

Lapostolle, F., & Alhéritière, A. (2020). To intubate or not intubate, that is still the question! European Journal of Emergency Medicine, 27(5), 387–388. https://doi.org/10.1097/MEJ.0000000000000726 DOI: https://doi.org/10.1097/MEJ.0000000000000726

Luckscheiter, A., Thiel, M., Zink, W., Eisenberger, J., Viergutz, T., & Schneider-Lindner, V. (2025). Utilization of non-invasive ventilation before prehospital emergency anesthesia in trauma – A cohort analysis with machine learning. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1). https://doi.org/10.1186/s13049-025-01350-1 DOI: https://doi.org/10.1186/s13049-025-01350-1

Orso, D., Vetrugno, L., Federici, N., D’Andrea, N., & Bove, T. (2020). Endotracheal intubation to reduce aspiration events in acutely comatose patients: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1). https://doi.org/10.1186/s13049-020-00814-w DOI: https://doi.org/10.1186/s13049-020-00814-w

Parks, D. J., Alter, S. M., Shih, R. D., Solano, J. J., Hughes, P. G., & Clayton, L. M. (2020). Rescue intubation in the emergency department after prehospital ketamine administration for agitation. Prehospital and Disaster Medicine, 35(6), 651–655. https://doi.org/10.1017/S1049023X20001168 DOI: https://doi.org/10.1017/S1049023X20001168

Prekker, M. E., Driver, B. E., Trent, S. A., Resnick-Ault, D., Seitz, K. P., Russell, D. W., … Semler, M. W. (2023). Video versus direct laryngoscopy for tracheal intubation of critically ill adults. New England Journal of Medicine, 389(5), 418–429. https://doi.org/10.1056/nejmoa2301601 DOI: https://doi.org/10.1056/NEJMoa2301601

Puolakkainen, T., Toivari, M., Puolakka, T., & Snäll, J. (2022). “A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients? BMC Emergency Medicine, 22(1). https://doi.org/10.1186/s12873-022-00669-7 DOI: https://doi.org/10.1186/s12873-022-00669-7

Robinson, C. (2022). Emergency neurological life support: Airway, ventilation and sedation protocol version 5.0.

Rubén Viejo-Moreno, Jiménez-Carrascosa, J. F., & Parra-Soriano, S. (2021). Análisis descriptivo de pacientes que requirieron manejo avanzado de vía aérea en emergencias prehospitalarias: Complicaciones y factores asociados al fracaso en el primer intento de intubación. Emergencias, 33, 447–453.

Saviluoto, A., Pappinen, J., Kirves, H., Raatiniemi, L., & Nurmi, J. (2023). Association between physician’s case volume in prehospital advanced trauma care and 30-day mortality: A registry-based analysis of 4,032 patients. Journal of Trauma and Acute Care Surgery, 94(3), 425–432. https://doi.org/10.1097/TA.0000000000003777 DOI: https://doi.org/10.1097/TA.0000000000003777

Suzuki, N., Doi, T., Abe, T., Michishita, T., Gakumazawa, M., & Takeuchi, I. (2024). Predictors of emergency interventions in acute airway obstructive diseases: A retrospective single-center observational study. Cureus. https://doi.org/10.7759/cureus.71031 DOI: https://doi.org/10.7759/cureus.71031

Takawira, N., Han, R. J., Nguyen, T. Q., Gaines, J. D., & Han, T. H. (2012). Spinal cord stimulator and epidural haematoma. British Journal of Anaesthesia, 109(4), 649–650. https://doi.org/10.1093/bja/aes335 DOI: https://doi.org/10.1093/bja/aes335

Tamilarasu, K. P., Aazmi, A., Vinayagam, S., Rajendran, G., Patel, S., & Aazmi, B. (2023). A prospective observational study of endotracheal intubation practices in an academic emergency department of a tertiary care hospital in South India. Cureus. https://doi.org/10.7759/cureus.36072 DOI: https://doi.org/10.7759/cureus.36072

Van Helmond, L. P. F. M., & Gresnigt, F. M. J. (2020). Safety of withholding intubation in gamma-hydroxybutyrate- and gamma-butyrolactone-intoxicated coma patients in the emergency department. European Journal of Emergency Medicine, 27(3), 223–227. https://doi.org/10.1097/MEJ.0000000000000649 DOI: https://doi.org/10.1097/MEJ.0000000000000649

West, J. R., O’Keefe, B. P., & Russell, J. T. (2021). Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation. Trauma Surgery and Acute Care Open, 6(1). https://doi.org/10.1136/tsaco-2020-000588 DOI: https://doi.org/10.1136/tsaco-2020-000588

Published

2025-06-19

Issue

Section

Health Sciences

How to Cite

Jadán Cumbe, A. M. ., Cedeño Nuñez , A. B., Calle Tello, L. D. ., Carrion Cordova, C. M. ., & Miranda Bajaña, J. F. . (2025). Airway Management in Acutely Neurologically Compromised Patients: A Narrative Review of Evidence-Based Strategies in Emergency Care. Multidisciplinary Journal Epistemology of the Sciences, 2(2), 1110-1135. https://doi.org/10.71112/3rxe2342

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