Author: James DuCanto, MD
It is a tenet of the scientific method to make systematic observations and measurements, and to experiment for the purpose of testing a hypothesis, leading to the modification or complete refutation of that hypothesis. In this case, a bunch of guys got together on a Sunday to chew up some food and mix it with beer and vinegar in order to provide a simulation of possibly one of the most daunting scenarios in prehospital airway management—the occurrence of solid food regurgitation, which completely occludes the patient’s airway.
Thankfully, events such as this are rare in prehospital medicine; however, as I have traveled to share the SALAD (for Suction-Assisted Laryngoscopy and Airway Decontamination) simulator with several midwestern prehospital organizations, the stories of impossibly contaminated airways encountered in the field inevitably emerge—skilled advanced life support paramedics are confronted with copious amounts of solid food regurgitation during treatment of out-of-hospital cardiac arrest and find themselves unable to adequately manage the airway, leading to a failure to rescue in these cases. It may sound provocative for me to say that if a patient experiences massive regurgitation of solid food contents during resuscitation, the result of that resuscitative effort will likely be a failure to rescue, but my limited exposure to this phenomenon suggests that this is true. This represents a new horizon for the SALAD simulation, and at this point, we have more questions than answers.
We learned many things during that simulation; most importantly, that in cases of extreme solid food regurgitation, the most important strategy is to scoop out enough solid food to intubate over the top of a thickly caked “carpet” of the contaminant, or conversely, to recognize when this decontamination maneuver is not going to be effective and to resort to front-of-neck access. The combination of Angus steak, cornbread stuffing and bow tie pasta mixed with a thin liquid really caught our imagination, as I hope it will yours. A more simple method of reproducing this simulation is to utilize Jello brand gelatin as the airway contaminant. (It smells better too!)