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Western Trauma Association critical decisions in trauma: airway management in adult trauma patients
  1. Carlos V R Brown1,
  2. Kenji Inaba2,
  3. David V Shatz3,
  4. Ernest E Moore4,
  5. David Ciesla5,
  6. Jack A Sava6,
  7. Hasan B Alam7,
  8. Karen Brasel8,
  9. Gary Vercruysse7,
  10. Jason L Sperry9,
  11. Anne G Rizzo10,
  12. Matthew Martin11
  1. 1Department of Surgery, University of Texas at Austin Dell Medical School, Austin, Texas, USA
  2. 2Deparment of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
  3. 3Department of Surgery, UC Davis, Davis, California, USA
  4. 4Department of Surgery, Denver Health, Denver, Colorado, USA
  5. 5Department of Surgery, University of South Florida, Tampa, Florida, USA
  6. 6Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
  7. 7Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  8. 8Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
  9. 9Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  10. 10Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA
  11. 11Department of Trauma Surgery, Scripps Mercy Hospital San Diego, San Diego, California, USA
  1. Correspondence to Dr Carlos V R Brown, Department of Surgery, University of Texas at Austin Dell Medical School, Austin, TX 78701, USA; Carlos.Brown{at}

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This is a recommended evaluation and management algorithm from the Western Trauma Association (WTA) Algorithms Committee addressing the prehospital and in-hospital airway management of adult trauma patients. Because there is a paucity of published prospective randomized clinical trials that have generated class I data, these recommendations are based primarily on published prospective and retrospective cohort studies and expert opinion of the WTA members. The final algorithm is the result of an iterative process including an initial internal review and revision by the WTA Algorithm Committee members and then final revisions based on input during and after presentation of the algorithm to the full WTA membership.

Airway management in the severely injured adult trauma patients begins from the time of first responder arrival and continues until a definitive airway can be established and maintained. Though airway management is important in both the prehospital setting and emergency department, the priorities differ slightly due to alterations in environment, personnel, equipment, expertise and experience. This WTA algorithm will review with most recent evidence and provide recommendations for airway management for the adult trauma patient in both the prehospital setting and emergency department. Cervical spine protection and immobilization, if indicated, will be assumed throughout all airway interventions in the algorithms below. The algorithms (figures 1 and 2) and accompanying comments represent a safe and sensible approach to the evaluation and management of the airway in the acutely injured patient. We recognize that there will be multiple factors that may warrant or require deviation from any single recommended algorithm and that no algorithm can completely replace expert bedside clinical judgment. We encourage institutions to use this as a general framework in the approach to these patients and to customize and adapt the algorithm to better suit the specifics of that program or location.

Figure 1

Algorithm for prehospital …

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