Technique
- Once the patient has been appropriately positioned, the clinician begins the SALAD procedure of ETI with the rigid suction catheter (RSC) in their right hand,held in an over-hand fashion so that the curve of the RSC mirrors the curve of the structures of the upper airway(Fig. 1a) .
- The RSC is inserted into the mouth and swept from side to side, continuously suctioning as it is advanced just ahead of the laryngoscope blade around the base of the tongue under direct visualization.
- The RSC is gripped tightly like a laryngoscope and used to displace the tongue and lower jaw in order to maximize space for laryngoscopy and subsequent tube delivery (Fig. 1b).
- As the RSC is advanced ahead of the laryngoscope, continuous suction clears the airway and ensures that the lens of the camera remains clean if the clinician is employing video laryngoscopy. The RSC is primarily responsible for displacing the structures of the upper airway until the blade of the laryngoscope has been optimally positioned (Fig. 1c).
- Once the laryngoscope is controlling the structures of the upper airway, the RSC can be used to suction the glottis and proximal trachea under direct visualization. The RSC is then withdrawn and re-inserted into the mouth to the left of the laryngoscope while maintaining constant visualization of the proximal esophagus and glottic opening. It is then advanced until the tip is sitting in the upper esophagus. This is referred to as the SALAD Park Maneuver (Fig. 1d).
- “Parking” the catheter in this position allows for the continuous suctioning of the hypopharynx even if the patient continues to actively vomit or hemorrhage and frees the operator’s right hand deliver the endotracheal tube. Next, the endotracheal tube is delivered with a constant awareness of optimizing the space and maintaining good visualization (Fig. 1e).
- Once positioned between the vocal cords, the lumen of the endotracheal tube is suctioned with a soft catheter to clear any residual contaminant prior to ventilation via the tube (Fig. 1f).
Reference
- DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. West J Emerg Med.2017;18(1):117–120. https://doi.org/10.5811/westjem.2016.9.30891
- Root CW, Mitchell OJL, Brown R, Evers CB, Boyle J, Griffin C, West FM, Gomm E, Miles E, McGuire B, Swaminathan A, St George J, Horowitz JM, DuCanto J. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resusc Plus. 2020 May 21;1-2:100005. doi: 10.1016/j.resplu.2020.100005. PMID: 34223292; PMCID: PMC8244406.
