High-flow nasal oxygen reduces the incidence of hypoxaemia and intra-procedural interruptions during gastrointestinal endoscopy

Abstract

Which eFONA procedure has the highest first-pass success (FPS) rate is currently unknown, particularly during a 'can't oxygenate, can't oxygenate' (CICO) emergency.Smartphone technology enables 'crowdsourcing' of observational data about infrequent eFONA events. The Airway App collects anonymised first-hand details regarding eFONA procedures via a free, smartphone, or desktop application. Further details of the Airway App methodology and ethical considerations of anonymous data-gathering are previously published. 1 The data is necessarily non-verifiable, but this is a limitation of many databases of rare events.Over a 37-month period (June 16, 2016eJuly 16, 2019) the Airway App was accessed > 6000 times. Of these, 303 recorded 'report a real case'; 259 from 37 countries were judged internally consistent. The three most common themes were male patients (76%), CICO events (67%), and obstructing airway pathology (44%). In the 174 CICO emergencies, nonsurgeons undertook 88% of eFONA procedures, a supraglottic airway (SGA) was attempted in 39%, and neuromuscular block was used in 44%. eFONA FPS in non-CICO vs CICO reports were 87% and 74%, respectively (P¼0.02). Table 7 shows FPS by procedure type in both non-CICO and CICO reports. Despite eventual eFONA success in 229 reports, 15% of these patients died.In conclusion, our data suggest SGA use and patient paralysis are underutilised in CICO management despite recommendations. 2 eFONA FPS is significantly lower during CICO compared with non-CICO settings. Of all techniques used during CICO, only bougie-assisted cricothyroidotomy approached a FPS 95% lower-limit confidence interval of 80%, which the authors believe to be an acceptable eFONA FPS rate.