Supraglottic Airway

A supraglottic airway (SGA) is a rescue airway device placed above the vocal cords to support oxygenation and ventilation when bag-mask ventilation or tracheal intubation is inadequate or delayed.

SGAs sit in the pharynx, forming a seal around the laryngeal inlet without passing through the vocal cords. This makes them faster and easier to place than endotracheal tubes — most SGAs can be inserted in seconds without direct visualization of the vocal cords, and success rates are high even for providers with limited airway experience.

Common SGA devices include:

• Laryngeal mask airway (LMA) — the original and most widely used SGA; an inflatable mask that seats over the laryngeal inlet
• i-gel — a non-inflatable SGA with a gel-like cuff that conforms to perilaryngeal anatomy; no cuff inflation required
• King Laryngeal Tube (King LT) — a dual-lumen device with proximal and distal cuffs; commonly used in prehospital settings

SGAs occupy a specific position in the airway management escalation ladder:

1. Basic maneuvers (head tilt, jaw thrust, oral/nasal airway)
2. Bag-mask ventilation
3. Supraglottic airway — when bag-mask ventilation is difficult or when intubation is not immediately available or has failed
4. Endotracheal intubation
5. Surgical airway (cricothyrotomy) — the final rescue pathway in CICO

SGAs have important limitations:

• No definitive airway protection — unlike an endotracheal tube, an SGA does not seal the trachea below the vocal cords, so aspiration risk remains (though second-generation SGAs include gastric drainage channels that reduce this risk)
• Ventilation pressure limits — SGAs typically cannot deliver the high airway pressures sometimes needed in patients with poor lung compliance
• Not a definitive airway — SGAs are rescue and bridging devices; in most clinical contexts, a patient who requires ongoing ventilatory support will ultimately need endotracheal intubation or a surgical airway

Despite these limitations, SGAs save lives precisely because they are fast, require less skill than intubation, and provide ventilation in the critical minutes when oxygenation would otherwise fail.

Related terms

• Airway — the passage the SGA supports
• CICO — the emergency in which SGA failure triggers surgical rescue
• Oxygenation — the function the SGA maintains
• Ventilation — the function the SGA supports