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

Emergency airway management is often complicated by the presence of blood,

emesis Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pregna ...

or other contaminants in the airway. For example, in out-of-hospital

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

(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, by a US anaesthetist Dr. Jim DuCanto. It was subsequently introduced into several US academic emergency medicine departments, culminating in its presentation at the 2015 Social Media and Critical Care Conference (SMACC). This 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 following description of the SALAD Technique is intended to provide a template for medical educators to practice this technique in a medical simulation setting, and does not constitute medical advice. Wikipedia does not generally approve of articles that serve as guides to perform procedures, however, many medical educators who wish to disseminate information regarding new and effective techniques to manage contaminated airways have sought a template upon which to build their simulation instructions, and this guide to the technique simply serves to provide that template. The SALAD technique consists of the following steps: Note that these images are using a hand-operated

suction Suction is the day-to-day term for the movement of gases or liquids along a pressure gradient with the implication that the movement occurs because the lower pressure pulls the gas or liquid. However, the forces acting in this case do not orig ...

device, but the principle for motorised suction is the same.

SALAD research

To date, 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. Two case reports in the peer-reviewed literature to date (Summer 2021) have described the SALAD technique as instrumental for emergency airway management in critically ill patients.

References

{{reflist Airway management