Which of the following is a contraindication to using an extraglottic airway device?

• A. Gag reflex
• B. Hypoxia
• C. Obtundation
• D. Respiratory arrest

Answer: (A)

The key idea is that extraglottic airway devices require a patient who will not fight and topically gag during placement. An intact gag reflex makes insertion risky and unreliable: it can trigger gagging or vomiting, which raises the chance of aspiration and can disrupt or dislodge the device. Because these devices sit above the glottis and do not provide the same level of airway protection as a true endotracheal tube, a patient with a gag reflex is not a good candidate for using one.

The other scenarios aren’t contraindications. In a hypoxic patient, quickly securing any airway—including an extraglottic device—can be life-saving. If a patient is obtunded, their airway reflexes may be reduced, which can make placement more tolerable and effective. In respiratory arrest, an extraglottic airway can be used as an immediate airway adjunct while preparing a definitive airway.