Oropharyngeal Airway (OPA) Review
The tongue is the most common airway obstruction in an unconscious patient. When a patient goes unresponsive and is laying on their back, the relaxed tongue falls to the back of the oropharynx blocking the airway. During our assessment, we should perform a head tilt-chin-lift to move the tongue from the back of the throat while checking for a carotid pulse and breathing for 5-10 seconds. As we work a code, keeping the airway open is vital to deliver adequate ventilations. To help us, we can insert an oropharyngeal airway to keep the patient’s tongue from falling to the back of the pharynx. The use of oropharyngeal airway (OPA) is today’s Pass ACLS tip topic.
The oropharyngeal airway is sometimes called an OPA or simply an oral airway.
Indications & Contraindications for Use of an OPA
The oral airway is indicated for unresponsive patients that can’t control their own airway and do not have a gag reflex.
The OPA is contraindicated for patients with an intact gag reflex. If a patient has a gag reflex but can’t control their own airway, an alternative device such as the nasopharyngeal airway (NPA) should be used.
Measuring and Inserting an Oral Airway
OPAs come in a wide variety of sizes from very small infant sizes that are only a few centimeters in length to extra large adult sized that are 15 cm or more. It’s important that we size an oral airway before attempting to insert one to ensure that it will work as intended and not cause any complications.
To measure an oral airway, simply hold the device next to the patient’s face and measure from the corner of the mouth to the angle of the jaw. Then use the one that is closest to the desired length.
Two techniques to properly insert an OPA include twisting and straight-in. The twisting method is most commonly used. If using the straight-in method, a tongue blade is required to keep the tongue from being pushed to the back of the pharynx during insertion. The flange of the OPA will remain outside the patient’s mouth – resting on the lips or teeth.
We don’t need to stop CPR to insert an oral airway. The oral airway can easily be measured and inserted while CPR compressions are being delivered. Once inserted, the oral airway can be left in place until we’re ready to intubate or insert another advanced airway. Keep in mind that inserting an advanced airway, is not a priority while running a code. We can do adequate CPR of 30 compressions to 2 breaths, defibrillate, and monitor end tidal CO2 using a BVM with an oral airway in place.
Possible Complications
If we begin to insert an oral airway and the patient starts to wretch, immediately remove the airway. Attempting to insert an oral airway into a patient with a gag reflex can lead to vomiting and possible aspiration. If a patient has a gag reflex and cannot control their own airway, an alternative device such as a nasal airway (NPA) should be used.
Using an oral airway that is too small could be swallowed or aspirated and/or push the tongue to the back of the throat, causing an airway obstruction.
Using an airway that’s too large could result in soft tissue damage leading to swelling or bleeding into the airway or laryngeal spasm.
Additional Uses of an OPA
It’s common, at some institutions, to use an oral airway as a bite block to protect the ET tube from occluding should the patient bite down. In these cases, the OPA is being used as a bite block and not as an airway.
