Considerations for emergency airway management and resuscitation in cancer patients: a review.

BACKGROUND

Cancer patients frequently present to the emergency department (ED) with malignancy or treatment-related critical illness, requiring airway intervention or resuscitation. Multiple factors such as anatomical distortion, treatment sequelae, frailty, and complex goals-of-care considerations create unique challenges. This narrative review aims to provide practical, evidence-informed guidance in airway management and resuscitation of oncologic patients.

METHODS

We conducted a review of the literature addressing airway management, physiologic alterations associated with malignancy and cachexia, pharmacologic considerations for rapid sequence intubation, and resuscitation outcomes in cancer populations. We synthesized relevant clinical guidelines and studies to develop an overview of recommendations applicable to ED practice.

RESULTS

Cancer patients present numerous airway management challenges due to tumor or surgical airway alternations, post-radiation fibrosis, edema, and bleeding. Physiologic factors-including reduced functional residual capacity, anemia, muscle wasting, and systemic inflammation-shorten safe apnea time, increase risk of peri-intubation hypoxia, and hemodynamic instability. Malnutrition, organ dysfunction, and chemotherapy toxicity alter pharmacokinetics, necessitating individualized selection and dosing of induction and paralytic agents. Early anticipation of difficulties in airway management, optimized preoxygenation, advanced airway techniques, and multidisciplinary involvement are essential. Resuscitation planning must incorporate realistic prognostication and clear discussions regarding code status. Late or absent documentation of goals-of-care remains common.

CONCLUSIONS

Airway management and resuscitation in cancer patients require a specialized, patient-centered approach. Future research should address comparative outcomes in the cancer population and support development of ED-specific oncologic protocols. Integration of structured goals-of-care frameworks and early palliative care help ensure ethically aligned, high-quality emergency care.