Airway management equipment and practice: time to optimise institutional, team, and personal preparedness

Gibbins, Matthew Llewelyn; Kelly, F. E.; Cook, Tim

doi:10.1016/j.bja.2020.06.012

Cited by 20 publications

(20 citation statements)

References 29 publications

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“…5 Regardless of the chosen technique, the airway manager must attain and maintain competence with its use in lower acuity clinical or simulation settings. 173 , 174 …”

Section: Implementation Of the Planned Strategy When Difficult Trachementioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

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“…5 Regardless of the chosen technique, the airway manager must attain and maintain competence with its use in lower acuity clinical or simulation settings. 173 , 174 …”

Section: Implementation Of the Planned Strategy When Difficult Trachementioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

View full text Add to dashboard Cite

show abstract

“…The team approach should emphasise closed-loop communication and the need to progress smoothly through the steps when challenges are encountered without the necessity of waiting for the inevitable deterioration in the patient's condition. [42][43][44] A dedicated team approach with centralisation of intubation sites may help in improving safety and performance, thereby reducing complications. 45 Such an approach may also have implications on the mental well-being of the team members, which is undoubtedly an issue we are facing during the pandemic and into the future.…”

Section: "We Not Me": Use a Team Approachmentioning

confidence: 99%

Airway management in COVID-19 : time to start thinking outside the box?

Hofmeyr

Sorbello

2021

Southern African Journal of Anaesthesia and Analgesia

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Faced with limited time, severely constrained resources and a lack of manpower in the face of the overwhelming numbers in Xerxes’ invading Persian Army, the Greeks strategised to halt their foe using two natural barriers which restricted movement: the Straits of Atremisium, and the narrow pass at Thermopylae. King Leonidas of Sparta led 7 000 mettlesome troops to engage at the Hot Gates, preparing to face a force today believed to have exceeded 150 000 fighters. When told that the Persians were so multitudinous that each volley of their arrows would block out the sun, Herodotus writes that the plucky Spartan soldier, Dienekes, replied laconically: “In the shade, then, we will fight!” The Battle of Thermopylae is history interwoven with legend, but speaks of the power of strategic interventions applied at the right place, at the right time, by the right people, even in the face of overwhelming odds.

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“…Allow organisations to express preference for equipment models: under normal circumstances, and especially when clinical staff are newly trained and stressed, standardised inventory is safety critical 4 5 —these communications enable this.…”

Section: Introductionmentioning

confidence: 99%

Developing the COVID-19 intensive care medical equipment distribution platform: outcomes and lessons learned

et al. 2021

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During the first wave of the coronavirus pandemic, the UK government took the decision to centralise the procurement, allocation and distribution of mission-critical intensive care unit (ICU) medical equipment. Establishing new supply chains in the context of global shortages presented significant challenges. This report describes the development of an innovative platform developed rapidly and voluntarily by clinical engineers, to mobilise the UK’s shared medical equipment inventory, in order to match ICU capacity to dynamically evolving clinical demand. The ‘Coronavirus ICU Medical Equipment Distribution’ platform was developed to optimise ICU equipment allocation, distribution, collection, redeployment and traceability across the National Health Service. Although feedback on the platform has largely been very positive, the platform was built for a scenario that did not fully materialise in the UK and this affected the implementation approach. As such, it was not used to its full potential. Nonetheless, the platform and the insights derived and disseminated in its development have been extremely valuable. It provides a prototype for not only optimising system capacity in future pandemic scenarios but also a means for maximally exploiting the large amount of new equipment in the UK health system, as a result of the coronavirus pandemic. This early stage innovation has demonstrated that a system-wide pooled information resource can benefit the operations of individual organisations. It has also generated numerous lessons to be borne in mind in innovation projects.

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Airway management equipment and practice: time to optimise institutional, team, and personal preparedness

Cited by 20 publications

References 29 publications

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Airway management in COVID-19 : time to start thinking outside the box?

Developing the COVID-19 intensive care medical equipment distribution platform: outcomes and lessons learned

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