Association between the availability of videolaryngoscopes and the incidence of emergency surgical airway in the perioperative setting of a large academic medical centre: a retrospective observational study

Fei, M.; Wanderer, Jonathan P.; Jiang, Yandong; Jacques, Paul J. St.

doi:10.1093/bja/aew374

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…However, our results are relevant for current practice as Fei et al reported that the rate of emergency surgical airways was unchanged from 2008 to 2015 despite increased use of video laryngoscopy for tracheal intubation. 26 Data abstraction in 2000 to 2012 claims relied on narratives by reviewers using primary data sources at liability insurers, which may result in missing information. However, reliability of assessments was acceptable (moderate to substantial: 0.436 to 0.664).…”

Section: Limitationsmentioning

confidence: 99%

Management of Difficult Tracheal Intubation

Aziz²,

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Difficult or failed intubation is a major contributor to morbidity for patients and liability for anesthesiologists. Updated difficult airway management guidelines and incorporation of new airway devices into practice may have affected patient outcomes. The authors therefore compared recent malpractice claims related to difficult tracheal intubation to older claims using the Anesthesia Closed Claims Project database. Methods Claims with difficult tracheal intubation as the primary damaging event occurring in the years 2000 to 2012 (n = 102) were compared to difficult tracheal intubation claims from 1993 to 1999 (n = 93). Difficult intubation claims from 2000 to 2012 were evaluated for preoperative predictors and appropriateness of airway management. Results Patients in 2000 to 2012 difficult intubation claims were sicker (78% American Society of Anesthesiologists [ASA] Physical Status III to V; n = 78 of 102) and had more emergency procedures (37%; n = 37 of 102) compared to patients in 1993 to 1999 claims (47% ASA Physical Status III to V; n = 36 of 93; P < 0.001 and 22% emergency; n = 19 of 93; P = 0.025). More difficult tracheal intubation events occurred in nonperioperative locations in 2000 to 2012 than 1993 to 1999 (23%; n = 23 of 102 vs. 10%; n = 10 of 93; P = 0.035). Outcomes differed between time periods (P < 0.001), with a higher proportion of death in 2000 to 2012 claims (73%; n = 74 of 102 vs. 42%; n = 39 of 93 in 1993 to 1999 claims; P < 0.001 adjusted for multiple testing). In 2000 to 2012 claims, preoperative predictors of difficult tracheal intubation were present in 76% (78 of 102). In the 97 claims with sufficient information for assessment, inappropriate airway management occurred in 73% (71 of 97; κ = 0.44 to 0.66). A “can’t intubate, can’t oxygenate” emergency occurred in 80 claims with delayed surgical airway in more than one third (39%; n = 31 of 80). Conclusions Outcomes remained poor in recent malpractice claims related to difficult tracheal intubation. Inadequate airway planning and judgment errors were contributors to patient harm. Our results emphasize the need to improve both practitioner skills and systems response when difficult or failed tracheal intubation is encountered.

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Section: Limitationsmentioning

confidence: 99%

Management of Difficult Tracheal Intubation

Aziz²,

et al. 2019

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“… Maintenance of competence . Use of ATI is decreasing 243 . When difficulty is predicted, lack of recent experience, confidence, or skills in ATI might tempt the airway manager to avoid its use despite indicators of it being the safest approach.…”

Section: Human Factors and The Anticipated Difficult Airwaymentioning

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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“…In a 2016 letter to the editor, Fei et al reported a drop in the rate of ATI from 0.26 in 2008 to 0.13 in 2015. 17 This was a secondary study finding and was not reflected in the letter's title, so would not necessarily be retrieved by a literature search. We were unable to identify other published studies documenting that the use of ATI is decreasing.…”

Section: Discussionmentioning

confidence: 99%

Diminution de l’incidence d’intubation trachéale éveillée dans la pratique anesthésique : une étude de cohorte historique des années 2014-2020 dans un établissement de soins tertiaires

Law

Thana

Milne

2022

Can J Anesth/J Can Anesth

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Purpose Awake tracheal intubation (ATI) is recommended in airway management guidelines when significant difficulty is predicted with airway management. Use of the technique may be declining, which may have implications for patient safety or for skills acquisition and maintenance. This historical cohort database study sought to determine if the use of ATI was decreasing in our adult tertiary care center. Methods With institutional research ethics board approval, we queried our anesthesia information management system for cases with ATI descriptors for each year from 2014 to 2020. Records of the retrieved cases were independently reviewed by all three authors to verify they met inclusion criteria for the ATI cohort prior to analysis for the primary outcome. Secondary outcome measures included airway device and route used for ATI, first attempt and ultimate success rates, and reported adverse issues recorded in cases of failed ATI or those requiring more than one attempt.

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Association between the availability of videolaryngoscopes and the incidence of emergency surgical airway in the perioperative setting of a large academic medical centre: a retrospective observational study

Cited by 9 publications

References 14 publications

Management of Difficult Tracheal Intubation

Management of Difficult Tracheal Intubation

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

Diminution de l’incidence d’intubation trachéale éveillée dans la pratique anesthésique : une étude de cohorte historique des années 2014-2020 dans un établissement de soins tertiaires

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