A Prospective Audit of Airway Code Activations and Adverse Events in Two Tertiary Hospitals

Abstract

Introduction: Airway management outside the operating room can be challenging, with an increased risk of difficult intubation, failed intubation and complications. We aim to examine airway practices, incidence of difficult airway and complications associated with airway code (AC) activation. Methods:We conducted a prospective audit of AC activations and adverse events in two tertiary hospitals in Singapore. We included all adult patients outside the operating room who underwent emergency intubation by the AC team after AC activation. Adult patients who underwent emergency intubation without AC activation or before the arrival of the AC team were excluded. Data were collected and documented by the attending anaesthetists in a standardised survey form shortly after their responsibilities were completed. Results:The audit was conducted over a 20-month period from July 2016 to March 2018, during which a total of 224 airway activations occurred. Intubation was successful in 218 of 224 AC activations, giving a success rate of 97.3%. Overall, 48 patients (21.4%) suffered an adverse event. Thirteen patients (5.8%) had complications when intubation was carried out by the AC team compared with 35 (21.5%) by the non-AC team. Conclusion:Dedicated AC team offers better success rate for emergency tracheal intubation. Non-AC team attempted intubation in the majority of the cases before the arrival of the AC team. Increased intubation attempts are associated with increased incidence of adverse events. Equipment and patient factors also contributed to the adverse events. A multidisciplinary programme including the use of supraglottic devices may be helpful to improve the rate of success and minimise complications.

Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry

“…In contrast to other studies, 10 11 the AC teams were activated more frequently outside working hours than during working hours in our study, which may be attributed to a lack of supervising staff in the wards and ICU on weekends, holidays, and nights. Because emergency intubation performed by primary physicians outside of working hours is associated with a lower success rate and higher complication rate compared to that performed during working hours, 12 13 it is highly recommended that the AC team provides continuous coverage.…”

“…Most studies have recommended a multidisciplinary model of the airway rapid response team outside of the operating room, including an anesthesiologist, ENT physician, emergency department physician or trauma surgeon, nurse, pharmacist, and respiratory therapist. 5 6 7 8 9 10 11 If effective teamwork, communication, and coordination are ensured among clinicians, an ENT physician can manage tracheostomy-related problems and create surgical airways. However, instead of including the ENT physician in all AC activations, we implemented a separate ENT airway call system, similar to a previous study.…”

Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study

“…[18,19] The respiratory cause was one of the most common causes of emergency intubation, with the internal medicine ward being the most common code activation site, which is consistent with the results of previous reports. [10,[14][15][16]20] This study demonstrated that the frequency of Code D-delta activation was equal during and outside office hours, similar to the results of other reports from tertiary care hospitals. [13,16,20] The Code D-delta team successfully handled 85% of intubations at the activation scene, whereas 10% (two cases) were appropriately reevaluated and transferred to the OR for flexible bronchoscope-assisted intubation by the otolaryngology resident and anesthesia staff.…”

“…[9][10][11] In some centers, the emergency airway response team is assigned to improve airway quality and reduce the associated risks and complications. [13][14][15][16] The members of the emergency airway team vary among centers and usually include multidisciplinary personnel, such as an anesthesiologist, otolaryngologist, emergency medicine physician, trauma surgeon, and risk managers. [13,15,16] Some studies have reported that the airway call team consists of an anesthesiologist and senior anesthesia resident.…”

“…[13][14][15][16] The members of the emergency airway team vary among centers and usually include multidisciplinary personnel, such as an anesthesiologist, otolaryngologist, emergency medicine physician, trauma surgeon, and risk managers. [13,15,16] Some studies have reported that the airway call team consists of an anesthesiologist and senior anesthesia resident. [16,17] In this study, the Code D-delta team originally consisted of an anesthesia resident with >12 months of experience who completed a 4-h advanced airway workshop course with a senior nurse anesthetist and an otolaryngology resident; the attending anesthesiologist and otolaryngologist staff were the consultants.…”