• Tatsuya Norii, Yohsuke Makino, Kana Unuma, Gary M Hatch, Natalie L Adolphi, Sarah Dallo, Danielle Albright, David P Sklar, and Darren Braude.
• Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: tanorii@salud.unm.edu.
• Ann Emerg Med. 2021 Mar 1; 77 (3): 285-295.

Study ObjectiveExtraglottic airway devices are frequently used during cardiac arrest resuscitations and for failed intubation attempts. Recent literature suggests that many extraglottic airway devices are misplaced. The aim of this study is to create a classification system for extraglottic airway device misplacement and describe its frequency in a cohort of decedents who died with an extraglottic airway device in situ.MethodsWe assembled a cohort of all decedents who died with an extraglottic airway device in situ and underwent postmortem computed tomographic (CT) imaging at the state medical examiner's office during a 6-year period, using retrospective data. An expert panel developed a novel extraglottic airway device misplacement classification system. We then applied the schema in reviewing postmortem CT for extraglottic airway device position and potential complications.ResultsWe identified 341 eligible decedents. The median age was 47.0 years (interquartile range 32 to 59 years). Out-of-hospital personnel placed extraglottic airway devices in 265 patients (77.7%) who subsequently died out of hospital; the remainder died inhospital. The classification system consisted of 6 components: depth, size, rotation, device kinking, mechanical blockage of ventilation opening, and injury. Under the system, extraglottic airway devices were found to be misplaced in 49 cases (14.4%), including 5 (1.5%) that resulted in severe injuries.ConclusionWe created a novel extraglottic airway device misplacement classification system. Misplacement occurred in greater than 14% of cases. Severe traumatic complications occurred rarely. Quality improvement activities should include review of extraglottic airway device placement when CT images are available and use the classification system to describe misplacements.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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