Course Description
The SALAD technique has revolutionized airway management in contaminated airways by integrating large-bore suctioning with laryngoscopy to improve intubation success and patient outcomes. Developed by Dr. Jim DuCanto, this method reduces aspiration risk, enhances visualization, and increases first-pass intubation success. It is now widely adopted in prehospital, emergency, anesthesia, and critical care settings as an essential skill in managing airway contamination crises.
- Description: Suction Assisted Laryngoscopy Training Program
- Creator: Jim DuCanto MD, Jonathan St George MD
- Includes: Online + Hands-On Curriculum
- Completion Time: 40-60 minutes
- Certificate available (with site subscription)
Learning Objectives
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Important Concepts for this Space
Important Skills for this Space
Meet the Creator
Not long ago, in the early era of video laryngoscopy, massive airway contamination was widely viewed as a major limitation, and in some settings, an absolute contraindication to using a video laryngoscope. Blood, vomit, secretions, and other airway contaminants could overwhelm the camera, obscure the anatomy, and render a powerful visualization tool useless.
Then Jim DuCanto, an anesthesiologist with a deep interest in airway management and device innovation, began to rethink the role of suction.
Instead of treating suction as a passive cleanup tool, DuCanto reframed it as an active airway management instrument. The suction catheter was no longer something used briefly before laryngoscopy or handed off once the blade entered the mouth. It became part of the intubation strategy itself: a device used to displace tissue, clear contamination, maintain the visual field, and coordinate with the laryngoscope.
James DuCanto, MD, is an anaesthesiologist, master educator, and innovator dedicated to improving airway management. He invented the SALAD (Suction-Assisted Laryngoscopy and Airway Decontamination) simulator and the SSCOR DuCanto Catheter.
That shift became SALAD:
Suction-Assisted Laryngoscopy and Airway Decontamination.
The impact was significant. By integrating large-bore suction devices, deliberate two-handed technique, simulation training, and video laryngoscopy, clinicians learned that contaminated airways did not have to defeat modern visualization. The problem was not simply the presence of blood or vomit. The problem was the absence of a method.
This learning space is about that method.
Here, you will explore how the devices, training tools, and technique came together to change the management of massively contaminated airways. You will learn how to use suction as an active procedural tool, how to coordinate suction and laryngoscopy, how to maintain a view under hostile conditions, and how to convert a chaotic airway into a controlled intubation sequence.
More importantly, you’ll learn how to recreate this innovative learning space to keep your own skills fresh and to train others in the technique. SALAD was designed to be shared, practiced, and taught, not just studied. This space serves as both an online learning resource and a physical training model that can be used in classrooms, simulation centers, skills labs, and clinical education programs.
SALAD is more than a suction technique. It is a practical mindset for one of the messiest, highest-risk scenarios in emergency airway management: don’t retreat from contamination; manage it deliberately.
The Essentials
What Is SALAD
Definition
SALAD stands for Suction-Assisted Laryngoscopy and Airway Decontamination.
It is a structured technique for managing the massively contaminated airway, where blood, vomit, secretions, or other fluid material threatens oxygenation, visualization, and safe intubation. The key idea is simple: suction is not just a cleanup tool. In SALAD, suction becomes an active airway instrument used before, during, and after laryngoscopy to clear contamination, create working space, preserve the view, and reduce the risk of pushing contaminated material deeper into the airway.
The technique was developed to address a known gap in airway training: traditional airway education often teaches suction as a brief preparatory maneuver, but not as an integrated procedural skill for severe, ongoing airway contamination.
Core Concept
The SALAD procedure uses a large-bore rigid suction catheter, usually controlled with the clinician’s right hand, while the laryngoscope is used with the left hand. The suction catheter leads the way into the mouth, clears fluid ahead of the laryngoscope, helps displace the tongue and soft tissue, and then is “parked” in the hypopharynx or proximal esophagus to provide continuous suction while the endotracheal tube is delivered.
In plain terms: clear first, scope second, suction continuously, intubate through the cleared path, then suction the tube before ventilating.
The End of the Yankauer
Massive airway contamination is not a cleanup problem. It is an airway control problem.
In contrast to the traditional Yankauer, the large-bore suction catheter is designed for that reality. In SALAD, suction becomes an active airway tool, not a passive accessory. It clears blood, vomit, and debris while also displacing tissue, opening space, and protecting the view during laryngoscopy.
The goal is simple: regain control of the airway environment before contamination steals the attempt. Standard suction may help around the edges. Large-bore rigid suction is for when the airway itself needs to be decontaminated, controlled, and kept open long enough to intubate.
Co-ordinated & Continuous
SALAD Is Coordinated and Continuous
SALAD is not “suction, then laryngoscopy.” It is not a quick cleanup followed by a normal intubation attempt. SALAD is a coordinated, continuous two-handed technique.
The laryngoscope and suction catheter work together from the beginning of the procedure. The left hand controls the laryngoscope, creates exposure, and guides the view. The right hand controls the suction catheter, clears contamination, opens working space, protects the lens or line of sight, and manages ongoing fluid before it can re-flood the airway.
In a massively contaminated airway, suction cannot be intermittent. Blood, vomit, and secretions do not pause just because the laryngoscope is in the mouth. If suction stops, the view disappears, the airway floods again, and the intubation attempt becomes reactive and unstable.
SALAD changes that rhythm.
The suction catheter stays active throughout the procedure. It clears the mouth before the blade advances, travels with the laryngoscope as the view develops, then remains positioned to continuously divert contamination while the tube is delivered. This is the essence of the technique: suction is not a separate step, it is part of the airway choreography.
The power of SALAD comes from coordination. One hand sees. One hand clears. Both hands solve the problem together.
Shocking Tales of a Horribly Soiled Airway
SALAD Explained
In Graphic Novel Style
In Shocking Tales of Massive Airway Contamination, creator Jim DuCanto and friends deliver a playful, comic-book-inspired video that pulls you right into the action, following a clinician as they face massive airway contamination for the very first time in a busy emergency department.
Get ready for an entertaining (and educational) ride through one of the most feared airway scenarios. With a healthy dash of humor, this video shows how the SALAD technique transforms panic into control, even when the airway is flooded with vomit, blood, and secretions.
Watch the story unfold—and see what happens when life really sucks.
The Bottom Line
The SALAD technique has transformed the way we tackle a contaminated airway. It combines large-bore suction with laryngoscopy to protect the lungs, clear the field, and nail first-pass success. Born from Dr. Jim DuCanto’s vision, SALAD is now a must-have, life-saving weapon in the hands of emergency, prehospital, anesthesia, and critical care teams facing the toughest, messiest airways.
What’s Next
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