Code Critical Airway: A Collaborative Solution to a Catastrophic Problem

Abstract

Background In 2006, a multi-disciplinary “Code Critical Airway” (CCA) Team was created at our institution. The objective of this study is to examine the demographics and outcomes of the patients for whom a CCA is activated. Methods A retrospective review was conducted of patients for whom a CCA was activated from 2008-2020. Data from 2006-2008 was not available due to timing of the implementation of the hospital’s electronic medical record system. The early period of the experience with CCAs (2008-2014) was compared to the later period (2015-2020) CCA activations. Results There were 953 CCA activations. Over time, there was a statistically significantly increase in the number of CCA activations. CCAs occurred in the emergency department in 274 (29.0%), intensive care unit in 255 (27.0%), step-down unit in 60 (6.4%), wards in 294 (31.1%), and elsewhere in 61 (6.5%) cases. CCAs were managed with direct laryngoscopy in 97 patients (10.2%), video laryngoscope in 160 patients (16.8%), fiberoptic bronchoscopy in 179 patients (18.8%), bougie in 7 patient (0.7%), replacement of a prior tracheostomy in 262 patients (27.5%), and creation of a new surgical airway in 95 patients (10.0%). The definitive management of the CCA was not recorded in 76 patients (8.0%). Seven patients required removal of a foreign body (0.7%). There was no intervention in 70 patients (7.3%). There was an increase in successful first attempts at obtaining an airway comparing our experience in the early period (2008-2014) compared to the later period (2015-2020) (P < 0 .001). There was also a decrease in number of CCAs requiring a surgical airway (P = .030). Conclusion Inculcation of aggressive early escalation of airway emergencies through implementation of a CCA Team has resulted in significant improvement in first attempt airway stabilization and a decrease in surgical airways.

Emergency front-of-neck access in cardiac arrest: A scoping review

“… 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 Of the 69 included studies, there was one randomised controlled trial and 68 observational studies. 10 , 11 , 12 , ...…”

“…The incidence of eFONA was described in 53 studies. 42 , 45 , 46 , 54 , 65 , 69 , 72 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 48 , 49 , 50 , 51 , 56 , 57 , 58 , 60 , 61 , 62 , 74 , 75 , 76 , 77 , 78 Studies were conducted across the pre-hospital setting ( n = 23, 43%), in-hospital setting ( n = 13, 25%), pre-hospital/in-hospital setting ( n = 8, 15%), and on the battlefield ( n = 9, 17%). There were important differences in the denominator used to calculate incidence across studies, including all EMS calls, patients in whom tracheal intubation was attempted, and undefined population types ( Table 2 ).…”

A Novel Multidisciplinary Team Activation for Patients with Severe Gastrointestinal Bleeding: Creation of the Code GI Bleed Protocol

“…Process metrics include activation frequency, case reviews, retrospective audits, ED length of stay, time to source control, time to anticoagulant reversal administration, time on vasopressors (if used), time to blood product administration, and the amount of blood products required. 16 , 17 We will also track the outcome metrics of in-hospital patient mortality and incidence of pulseless electrical activity cardiac arrest with return of spontaneous circulation. Finally, we plan on an economic analysis to evaluate the financial benefit of protocol usage versus matched controls.…”