Basic vs Advanced Airway Management: A Comprehensive Comparison

Airway management is a crucial part of emergency care and can directly impact whether a patient survives their injury or illness. It is usually needed in emergency situations such as trauma, cardiac arrest, respiratory failure or administering anaesthesia during surgery.

The purpose of this technique is to ensure adequate oxygen and ventilation, as these are two fundamental requirements of life. In a nutshell, it’s about making sure there is a clear pathway for airflow between a person’s lungs and the air we breathe. 

The term ‘airway management’ itself refers to the medical procedures that must be performed in order to make this happen. This can be done by either clearing obstructions or facilitating the movement of air in and out of the lungs.

Airway management techniques can be broadly classified into two categories: basic and advanced. Each approach has its own specific methods and equipment and requires certain skills.

Understanding the differences between these two approaches is crucial for anyone involved in patient care, from first responders to anesthesiologists, and that’s exactly what we’re going to look at in this comprehensive guide. 

What’s involved in basic airway management? 

Basic airway management involves non-invasive techniques that do not necessarily require specialised equipment or high levels of training.

This basic method is designed to restore and maintain a clear airway in an unconscious or semi-conscious patient who could otherwise be at risk of airway obstruction.

With that in mind, some of the common basic airway management techniques include: 

1. The head tilt-chin lift: This manual technique requires users to reposition the head and lift the chin to open the airway. This is typically used in patients without suspected spinal injury.
2. Jaw thrust manoeuvre: This manoeuvre is recommended in trauma patients with potential cervical spine injury as it avoids neck movement while displacing the jaw forward.
3. Oropharyngeal airway (OPA): For OPA, a curved plastic device is inserted into the mouth to prevent the tongue from obstructing the airway. This is most suitable for unconscious patients without a gag reflex.
4. Nasopharyngeal airway (NPA): The NPA approach requires a soft rubber or plastic tube that is inserted into the nasal passage to bypass obstructions. Again, this is often used in semi-conscious patients or those with a strong gag reflex.
5. Suctioning: Lastly, suctioning is used to clear the airway of secretions, vomit or blood using a suction catheter is an essential aspect of basic airway maintenance.

The advantages (and disadvantages) of basic airway management

There are several reasons that basic airway management techniques will be chosen over more advanced procedures, and understanding the benefits is helpful for those administering care. 

The advantages of the techniques outlined above include: 

• These are rapid and easy to perform 
• They require minimal training 
• These techniques are useful in pre-hospital and low-resource settings
• In most cases, no specialised equipment is required

Of course, there are some limitations to these techniques and we are going to share these as well. Basic techniques can be limited in the following ways: 

• These methods are less effective in severe airway obstruction
• They are not suitable for prolonged ventilation
• The risk of aspiration remains if not combined with other interventions

What’s involved in advanced airway management? 

As expected, advanced airway management involves more invasive techniques and specialised equipment to secure the airway.

These procedures are typically performed by highly trained healthcare professionals such as paramedics, emergency physicians and anesthesiologists. Advanced airway management techniques include:

1. Endotracheal intubation (ETI): This technique involves the insertion of a tube into the trachea through the mouth (or nose) using a laryngoscope. ETI is the most common and trusted technique for airway protection and mechanical ventilation.
2. Supraglottic airway devices (SGAs): Devices like the laryngeal mask airway (LMA) offer an alternative to this intubation technique, sitting above the vocal cords and providing effective ventilation.
3. Cricothyrotomy: This is a surgical airway technique that involves an incision through the cricothyroid membrane to establish airway access. This is typically only used in extreme emergencies where intubation is not possible.
4. Tracheostomy: A longer-term solution involving a surgical opening into the trachea. This method is performed in cases that require extended mechanical ventilation.
5. Video laryngoscopy: Lastly, the video laryngoscopy is an advanced tool that offers medical professionals visual guidance during intubation, improving success rates and minimising complications.

The advantages (and disadvantages) of advanced airway management

Understanding the benefits of these more advanced techniques makes it easier to determine when more serious intervention is needed. Keeping that in mind, some of the biggest advantages of advanced methods include:

• These techniques provide a definitive airway
• They can reduce the risk of aspiration
• They allow for mechanical ventilation
• These techniques are suitable for prolonged airway support
• Users will have greater control over oxygenation and ventilation
  

However, even more advanced airway management techniques will still have some limitations, and for these methods, some of the disadvantages include:

• These techniques require significant training and experience
• There is an increased risk of complications like trauma, oesophagal intubation and infection
• These methods can be time-consuming compared to basic techniques
• It’s not always feasible to apply these techniques in pre-hospital or resource-limited environments

When to use basic vs advanced airway management

In many cases, the basic and advanced airway management techniques are complementary rather than mutually exclusive. For instance, a basic manoeuvre might initially be used while preparing for intubation and more advanced techniques used later during surgery. 

But we’ll now take a quick look at the key differences between the two and when to apply each method. 

Basic techniques

Basic airway management is non-invasive, requires minimal equipment and expertise, and poses less of a risk of complications. This is ideal for initial response or when advanced tools and skills are not available.

These techniques can buy time until a more definitive airway can be established, and in most cases, this is only a short-term solution that offers partial airway protection. 

Advanced techniques 

On the other hand, advanced airway management methods are more invasive and specialised and, therefore, must be administered by someone with advanced medical training. These techniques take longer to implement and require more equipment, but they provide longer-term solutions and more airway control.

These techniques are likely to be employed when basic measures fail and they are critical during surgery, respiratory failure or severe trauma.

In summary 

As we can see, basic and advanced airway management represent two ends of a spectrum of life-saving techniques. While the basic methods are essential for quick initial response, advanced techniques offer longer-term, more effective solutions in critical care and surgical environments.