Thyroid cartilage elevation maneuver: a novel and easy-to-perform method to insert a supraglottic airway device

To the Editor:A supraglottic airway device(SAD)can be used instead of an endotracheal tube(ET)in emergency situations.There are two types of SAD,cuffed and non-cuffed,the ease of use and success rates of which are similar.Compared to ET insertion,SAD insertion is quick and simple,while providing comparable ventilation.The 2019 American Heart Association guideline recommends SAD insertion in emergency situations,such as out-of-hospital cardiac arrest.[1,2]However,the success of SAD insertion is not easily ascertained.According to one study,when a SAD was used in an emergency medical service(EMS)setting,airway failure was not recognized in 13.8%of patients.[3]Incorrect positioning of a SAD is evidenced by bite block malalignment with the incisors and ineffective gas exchange(characterized by thoracic and“front of neck”excursions,inadequate tidal volume,low arterial oxygen saturation[SpO_(2)],poor capnograph trace,high airway pressure,and air leak).[1,4]Failure to insert a SAD to the proper depth typically results from the resistance of structures around the hypopharynx.[5]In this study,we introduce the thyroid cartilage elevation(TCE)maneuver,a simple and novel method that facilitates correct insertion of a SAD.