Guide to Using an Oropharyngeal Airway in Basic Life Support (2025)

An oropharyngeal airway, a key component in BLS training, is a device used during CPR to prevent airway obstruction by keeping the tongue away from the throat. Its easy insertion helps optimize ventilation, thereby enhancing the chances of successful resuscitation

How to Use Oropharyngeal Airway?

  1. Position the patient: Lay the patient on their back on a firm surface with the head in a neutral position for proper alignment during oropharyngeal airway insertion.
  2. Measuring and Sizing: Determine the size by measuring from the mouth corner to the jaw angle, using age-appropriate formulas or color-coded guides for pediatric patients.
  3. Open the Airway: Tilt the patient's head back to align the oral and pharyngeal axes for optimal insertion and ventilation.
  4. Insertion Technique: With the curved part upwards, gently lift the patient's chin and slide the airway along the mouth roof until the flange touches the lips. Confirm placement by checking for chest rise and fall.

Guide to Using an Oropharyngeal Airway in Basic Life Support (1)

1. Positioning the Patient

  • Begin by surveying the scene to ensure it is safe for both the rescuer and the patient. Remove any potential hazards or dangers before proceeding with medical interventions.
  • Evaluate the patient's level of responsiveness by attempting to stimulate them verbally or by touch. If the patient is unresponsive, proceed to assess breathing and initiate emergency procedures.
  • Carefully position the patient in a supine (lying on their back) position on a firm surface. Ensure the head is in a neutral position, aligning the ear canal with the shoulder.

2. Measuring and Sizing the Oropharyngeal Airway

Utilize a sizing guide or ruler to measure the distance from the corner of the patient's mouth to the angle of the jaw. This measurement will help determine the appropriate size of the oropharyngeal airway.

Choose the correct size of the oropharyngeal airway based on the measured distance. Pediatric sizes are often color-coded for quick identification.

Sizing for Different Age Groups:

Ensuring proper sizing of oropharyngeal airways is vital for maximizing effectiveness and minimizing complications. The approach to sizing varies across age groups, accounting for anatomical differences and specific patient requirements:

  1. Infants (0-1 year): Utilize pediatric sizing guides or color-coded indicators tailored to this age group. Employ a gentle approach during insertion, considering the delicate nature of the infant's airway. Choose smaller-sized oropharyngeal airways that suit the measured dimensions.
  2. Children (1-8 years): Consider the developmental stage of children within this age range. Pediatric oropharyngeal airways are often color-coded for swift identification. Utilize weight-based measurements to ensure the chosen airway aligns with the child's weight.
  3. Adolescents (8-12 years): As patients transition from childhood to adolescence, anticipate a gradual increase in airway dimensions. Transition to adult-sized oropharyngeal airways smoothly as needed. Confirm that the selected airway neither surpasses nor falls short for the adolescent patient, aiming for optimal fit during emergency interventions.
  4. Adults (12 years and older): Recognize that adults typically require larger-sized oropharyngeal airways. Base measurements on the distance from the mouth's corner to the jaw's angle. Choose the correct size to enable effective ventilation while minimizing the risk of complications like airway obstruction or soft tissue trauma.

3. Opening the Airway

Lilt the patient's head backward by placing one hand on the patient's forehead and gently lifting the chin with the other hand. This action helps to align the oral and pharyngeal axes, facilitating easier insertion.

Using the thumb and index finger, gently lift the patient's chin upward to create a sniffing position. This position optimizes the alignment of the airway for successful insertion.

4. Insertion Techniques

  1. Select the Correct Hand: Hold the oropharyngeal airway with the curved portion facing upward, using your dominant hand.
  2. Insert the Airway: Slide the oropharyngeal airway along the roof of the mouth, following the natural curve. Insert it until the flange rests against the patient's lips. Ensure that the airway is not oriented backward, which could cause obstruction.
  3. Confirm Placement: Observe the patient's chest rise and fall to confirm effective ventilation. If ventilation is not achieved, reassess the airway placement, and consider alternative methods.
  4. Secure the Airway: To prevent accidental displacement, secure the oropharyngeal airway in place using tape or by tying it to the patient's head, particularly in dynamic or transport situations.

When to Use the Oropharyngeal Airway

Oropharyngeal airways are essential in BLS, particularly for unconscious patients, forming a vital part of initial airway management steps. Here are the key indications for using an oropharyngeal airway:

  1. Unconscious Patients: Oropharyngeal airways are primarily used in unconscious patients who cannot maintain their own airways. This is often encountered in scenarios such as cardiac arrest, trauma, or drug overdose.
  2. Lack of Gag Reflex: The absence of a gag reflex is a key indicator of oropharyngeal airway use. The device helps prevent the tongue from falling back and obstructing the airway in patients who are unresponsive and lack this protective reflex.
  3. Cardiopulmonary Resuscitation: When chest compressions and rescue breaths are being administered during CPR, an oropharyngeal airway facilitates effective ventilation. It helps maintain an open airway and enhances the delivery of rescue breaths.
  4. Inadequate Breathing: When a patient is breathing inadequately or not breathing at all, using an oropharyngeal airway help ensure proper airflow, promoting oxygenation and ventilation.
  5. Prophylactic Use During Intubation: Oropharyngeal airways are sometimes used prophylactically during endotracheal intubation to facilitate the insertion of the endotracheal tube.
  6. During Transfer of Patients: Oropharyngeal airways is used when transferring unconscious or sedated patients, ensuring their airways remain patent during the transfer process.
  7. In Conjunction with Bag-Valve-Mask Ventilation: When using a bag-valve-mask device for ventilation, an oropharyngeal airway enhances the ventilations' effectiveness by preventing airway obstruction.

Knowing when to use an oropharyngeal airway is essential for healthcare providers and first responders, as this device plays a critical role in maintaining a clear airway in specific emergency situations.

Guide to Using an Oropharyngeal Airway in Basic Life Support (2)

In what scenarios is the use of an oropharyngeal airway contraindicated?

Despite their usefulness in airway management, oropharyngeal airways are unsuitable in certain conditions and scenarios. Here are scenarios in which it is advisable to avoid the use of oropharyngeal airways:

  1. Conscious or Semi-conscious Patients: Oropharyngeal airways should not be used in conscious or semi-conscious patients. Inserting the device in a patient with a gag reflex causes discomfort, increases the risk of vomiting, and leads to airway obstruction.
  2. Intact Gag Reflex: Patients with a strong and intact gag reflex should not receive oropharyngeal airways. Inserting the device stimulates the gag reflex, potentially causing the patient to gag or vomit.
  3. Facial Trauma or Suspected Skull Fractures: In cases of facial trauma or suspected skull fractures, the use of oropharyngeal airways should be avoided. These conditions predispose the patient to additional complications, and alternative airway management methods should be considered.
  4. Presence of a Foreign Body in the Airway: If there is evidence or suspicion of a foreign body in the airway, inserting an oropharyngeal airway push the object further down or cause additional harm. Prioritize airway clearance and use alternative methods.
  5. Patients with Known Allergies or Intolerance: Some patients have known allergies or intolerances to the materials used in oropharyngeal airways. In such cases, alternative airway management options should be explored.
  6. Patients with Trismus (Lockjaw): Trismus, or lockjaw, involves the involuntary contraction of the jaw muscles, making it challenging to insert an oropharyngeal airway. Attempting to force an airway in such cases leads to soft tissue trauma.
  7. Maxillofacial Surgery or Oral Procedures: Patients who have undergone recent maxillofacial surgery or oral procedures have altered anatomy or compromised tissue integrity, making using oropharyngeal airways inappropriate. Consultation with a specialist is necessary.
  8. Uncontrolled Head and Neck Injuries: In situations where there are uncontrolled head and neck injuries, the insertion of an oropharyngeal airway exacerbate existing trauma. Consider alternative airway management strategies and seek expert guidance.
  9. Patients with Known Esophageal Disease or Dysfunction: Patients with known esophageal disease or dysfunction have an increased risk of complications with oropharyngeal airway insertion. These individuals benefit from alternative airway management approaches.

Recognizing these contraindications is crucial to prevent potential complications.

Why is the Oropharyngeal Airway Important in Basic Life Support?

The oropharyngeal airway is important in Basic Life Support (BLS) because it helps maintain a clear and open airway in unconscious or unresponsive patients. By preventing the tongue from obstructing the airway, the oropharyngeal airway facilitates effective ventilation during cardiopulmonary resuscitation (CPR). This simple yet crucial device aids in the delivery of rescue breaths, allowing BLS providers to support oxygenation and ventilation, essential components of the life-saving measures performed during cardiac emergencies.

How is the Oropharyngeal Airway Different from Nasopharyngeal and Endotracheal Tubes?

The oropharyngeal airway is inserted through the mouth and sits in the oropharynx, preventing tongue obstruction. In contrast, the nasopharyngeal airway is inserted through the nose and sits in the nasopharynx, suitable when oral insertion is challenging. Endotracheal tubes are advanced through the mouth or nose into the trachea, securing an airway directly to the lungs, commonly used in advanced airway management.

A recent study compared the effects of inserting airways in the throat (oropharyngeal) and nose (nasopharyngeal) during anesthesia in 24 patients needing a specific type of intubation. Results showed that there was a significant increase in blood pressure after nasopharyngeal airway insertion, while oropharyngeal insertion had no such effect.

What are the Different Types of Oropharyngeal Airway?

The 3 different types of Oropharyngeal Airway are:

  1. Guedel Airway: Named after Arthur Guedel, this is a commonly used type of oropharyngeal airway with a curved shape designed to fit the anatomy of the oropharynx. It is available in various sizes to accommodate different age groups.
  2. Berman Airway: Similar to the Guedel airway, the Berman airway has an additional channel along its length, allowing for suctioning of secretions without removal of the airway.
  3. Ovassapian Airway: This specialized airway has an open channel, permitting the passage of a fiberoptic bronchoscope. It is often used in advanced airway management scenarios.

How do you determine the right size of an oropharyngeal airway for a specific patient?

To determine the right size of an oropharyngeal airway for a specific patient, measure the distance from the corner of the patient's mouth to the angle of the jaw on the same side. Choose an oropharyngeal airway size that matches this measured distance. For pediatric patients, use age-appropriate formulas, color-coded guides, or pediatric-specific sizing tools. Regularly reassess the patient's condition and the suitability of the airway, and select the appropriate width to accommodate the patient's oral anatomy without causing trauma. Use disposable sizing guides, pre-packaged kits, or rulers for accurate measurement.

What are the Potential Complications of Incorrect Oropharyngeal Airway Insertion?

Incorrect insertion of an oropharyngeal airway leads to various complications, including:

  1. Airway Obstruction: Improper sizing or insertion causes partial or complete airway obstruction, limiting the effectiveness of ventilation and compromising oxygenation.
  2. Soft Tissue Trauma: Forceful or incorrect insertion results in soft tissue trauma, including damage to the lips, gums, teeth, or the posterior pharyngeal wall.
  3. Gag Reflex Induction: In conscious or semi-conscious patients, inappropriate insertion stimulates the gag reflex, causing discomfort, vomiting, and an increased risk of aspiration.
  4. Laryngospasm: Stimulation of the larynx during insertion triggers laryngospasm, a sudden closure of the vocal cords, leading to respiratory distress.
  5. Epiglottis Entrapment: Incorrect insertion leads to the epiglottis becoming caught in the oropharyngeal airway, potentially causing airway obstruction and compromising ventilation.
  6. Esophageal Intubation: In rare cases, the oropharyngeal airway is inadvertently inserted into the esophagus instead of the trachea, leading to inadequate ventilation.
  7. Aspiration: If the patient is not properly positioned or the oropharyngeal airway is too long, there is an increased risk of regurgitation and aspiration of gastric contents.
  8. Dislodgement: The oropharyngeal airway becomes dislodged during patient movement or transportation, diminishing its effectiveness and potentially causing airway obstruction.
  9. Inadequate Ventilation: Incorrectly sized or positioned oropharyngeal airways is adequately maintain an open airway, leading to ineffective ventilation and compromised oxygenation.
  10. Facial Injuries: During insertion, particularly in cases of uncooperative patients or those with facial trauma, there is a risk of causing additional injuries to the face or mouth.

Healthcare providers must adhere to proper sizing, insertion techniques, and patient assessment to minimize the risk of complications associated with oropharyngeal airway use. Regular training and ongoing education are essential to maintain proficiency in airway management and enhance patient safety.

What Are Some Common Misconceptions About Using an Oropharyngeal Airway?

Here are some of the most common misconceptions about using oropharyngeal airways:

  • Forceful Insertion without Sizing: Forceful insertion or incorrect sizing leads to complications; proper measurement is crucial.
  • One Size Fits All Ages: Oropharyngeal airways come in various sizes, and selecting the right size is critical, especially for pediatric patients.
  • No Need for Continuous Monitoring: Regular monitoring is essential; adjustments is needed based on the patient's condition.
  • Insertion Without Proper Head Positioning: Proper head positioning is crucial for successful insertion; incorrect positioning hinders effectiveness.
  • Insertion Without Lubrication: Lubrication is important for smooth insertion and reducing friction.
  • Sole Option for Airway Management: Oropharyngeal airways are one tool; other options like nasopharyngeal airways or advanced technique is more appropriate.

Addressing these common misconceptions is crucial for safely and effectively using oropharyngeal airways in clinical settings.

How Has the Use of Oropharyngeal Airways Evolved in Recent Years?

Recent advancements in the design and application of oropharyngeal airways have enhanced patient outcomes. Technological innovations have led to the development of airways with enhanced features, such as anatomically shaped designs that better conform to the natural contours of the airway. These advances aim to reduce the risk of complications associated with traditional oropharyngeal airways, such as soft tissue trauma or airway obstruction.

Additionally, there has been an increased emphasis on the importance of proper sizing and patient assessment to ensure the optimal selection of airways for different age groups. Training and educational programs for healthcare providers have also evolved to incorporate the latest evidence-based practices, enhancing proficiency in oropharyngeal airway insertion techniques.

Sources:

National Institutes of Health (NIH) - PubMed

American Journal of Emergency Medicine

Cardiovascular changes following insertion of oropharyngeal and nasopharyngeal airways - PubMed

Guide to Using an Oropharyngeal Airway in Basic Life Support (2025)

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