User:Tricky999/sandbox

Suction Assisted Laryngoscopy Airway Decontamination (SALAD) is incremental step-wise approach to the management of a massively contaminated airway.



Emergency airway management is often complicated by the presence of blood, emesis or other contaminants in the airway. For example in out-of-hospital cardiac arrest (OHCA), vomiting and regurgitation have a reported incidence of 20–30%. The traditional approach to the contaminated airway involves suctioning the airway and repositioning the patient, which can effectively manage airway soiling in many, but not all, cases. However, traditional airway management education has not included the integration of a simultaneous suctioning and airway decontamination skill set as a technique that can be deployed in the setting of large volume contamination and clinicians frequently underestimate the importance of suction as part of airway management.

This has led to the development of the SALAD technique, and the creation of modified airway manikins to allow for practice in these techniques.

History
SALAD was developed as a simulation exercise in 2014 in multiple US academic emergency medicine departments, culminating in its presentation at the 2015 Social Media and Critical Care Conference (SMACC) which raised the profile of the technique internationally. Following its introduction to the international community at SMACC, multiple medical educators introduced the technique in their own institutions and services across Australasia, Europe and Asia.

Technique
The SALAD technique consists of the following steps: Note that these images are using a hand-operated suction device, but the principle for motorised suction is the same.

SALAD research
At present, there have been no large, randomised controlled trials (RCTs) of SALAD versus conventional emergency airway management strategies in real patients. The sporadic incidence of massive airway contamination during intubation attempts mean that an RCT of SALAD versus usual care is likely to be unfeasible to conduct. However, there is a growing body of lower quality evidence (simulation studies, and studies utilising observational data from patients) that are encouraging in terms of increasing clinician's confidence in managing severely contaminated airways and improving intubation success rates as well as time to successful intubation    in cases of significant airway soiling.