When should I consider referring a patient for advanced airway management in a primary care environment?

In a primary care setting, you should consider referring a patient for advanced airway management when they are unable to maintain their airway or ventilation adequately, particularly in the context of major trauma or severe respiratory compromise. This includes situations where basic airway maneuvers and adjuncts are insufficient to secure the airway, or when there is a failure of less invasive airway management techniques. Immediate referral is critical if the patient shows signs of airway obstruction, absent airway reflexes, or deteriorating respiratory status that cannot be managed safely in primary care. In such cases, rapid sequence induction (RSI) and intubation are the definitive methods for securing the airway, but these are typically performed in hospital or pre-hospital emergency settings by trained personnel ².

For patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or obesity hypoventilation syndrome, referral for advanced airway management or specialist assessment should be considered if non-invasive treatments such as CPAP or mandibular advancement splints are not tolerated or ineffective, or if there are anatomical obstructions or persistent symptoms despite initial management ¹.

Recent evidence from out-of-hospital cardiac arrest scenarios supports the importance of early advanced airway management to improve outcomes, emphasizing that delays in securing the airway can worsen prognosis (White et al., 2018). While this evidence primarily applies to emergency settings, it underscores the need for timely referral when airway compromise is suspected in primary care.