Insight

Things can get a little complicated when we’re trying to secure a patient’s airway with an endotracheal tube emergently. Contamination of the airway with gastric contents, blood, and secretions is a significant concern in emergencies when we don’t have the luxury of patients fasting before we intubate them. When this happens, we need to employ Suction-Assist Laryngoscopy and Airway Decontamination (SALAD), a technique created by Dr Jim DuCanto, in which a large-bore suction catheter is used to prevent airway soiling during laryngoscopy when there is profuse airway contamination.

With SALAD, the suction catheter is integrated into the laryngoscopy procedure. First, a rigid large-bore suction catheter is placed in the mouth before the laryngoscope, used to distract the jaw and suction the airway. If there is continuous contamination, the catheter is inserted into the proximal esophagus to the left of the laryngoscope blade. This allows for continuous suction of emesis, which reduces aspiration and improves the airway view.

-Brendan Tarantino

Reference

Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System, James DuCanto, MD, Karen Serrano, MD, & Ryan Thompson, MD

Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD) Training on Intubation Quality Metrics, Matt Jensen, Amir Louka, MD, & Benjamin Barmaan, MD

The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study, Lin et al.

EMCrit Podcast 196 – Having a Vomit SALAD with Dr. Jim DuCanto, Scott Weingart, MD FCCM

Jellybean 051. Jim DuCanto interview, Doug Lynch, MA, MBBS, MPHTM

The Basics of The Salad Technique, James DuCanto, MD