Institutional preparedness to prevent and manage anaesthesia‐related ‘can't intubate, can't oxygenate’ events in Australian and New Zealand teaching hospitals

Abstract

Summary It is unclear how the recent local and international focus on systems issues and human factors in ‘can't intubate, can't oxygenate’ events has impacted institutional preparedness in Australia and New Zealand. This study attempts to capture a snapshot of current practices in Australian and New Zealand teaching hospitals with regard to preparedness to prevent and manage ‘can't intubate, can't oxygenate’ events. All Australian and New Zealand College of Anaesthetists’ teaching hospitals were invited to complete an online survey consisting of 33 questions on terminology, equipment, cognitive aids, training and quality assurance. Follow‐up was by both email and telephone. Responses were received from 129 (91%) of the 142 sites. The survey revealed both countries have largely moved to point‐of‐care ‘can't intubate, can't oxygenate’ equipment. There were regional differences reported, with Australia favouring equipment, cognitive aids and teaching that supports a combined cannula and scalpel approach to ‘can't intubate, can't oxygenate’, whilst New Zealand favours those promoting a scalpel‐only approach. A lack of consistency with the terminology used around ‘can't intubate, can't oxygenate’ both within and between the two countries was also identified. This survey has revealed a generally reassuringly high degree of institutional preparedness to prevent and manage ‘can't intubate, can't oxygenate’ events across both countries but with strong regional differences in approaches. Little is known of the institutional practices outside these countries, making international comparison difficult.

Welcome to the era of universal airway management

“…That the acronym ‘eFONA’ is incomprehensible to the uninitiated and only decipherable to English‐speakers also weakens its universality . A recent survey of anaesthetists found the dominant term to be ‘emergency cricothyroidotomy’, suggesting a disconnect between the terminology of the literature and the clinical environment.…”

Preparing for, and more importantly preventing, ‘cannot intubate, cannot oxygenate’ events

“…In this issue of Anaesthesia , Rehak and Watterson obtained a 91% response rate in their survey investigating the institutional preparedness of anaesthesia teaching hospitals in Australia and New Zealand for CICO emergencies. This essentially establishes findings for an entire population of teaching hospitals, avoiding the need for inference statistics about a population from a smaller sample – a rare event in research.…”

“…Although the Australian and New Zealand College of Anaesthetists (ANZCA) has highlighted CICO preparedness as one of its three teaching priorities, as Winston Churchill said ‘ however beautiful the strategy, you should occasionally look at the results ’ (https://www.wsj.com/articles/dont-quote-churchill-on-that-1514330569). Rehak and Watterson do this in detail, identifying and quantifying relevant issues in order to enable further improvements in CICO management .…”

“…Rehak and Watterson investigated several equipment‐related issues . These included the type of cricothyrotomy equipment available in each hospital, and whether point‐of‐care CICO equipment packs, used to perform a cricothyrotomy, were accessible and ready to use in each operating theatre or location where airway management occurs.…”

“…These included the type of cricothyrotomy equipment available in each hospital, and whether point‐of‐care CICO equipment packs, used to perform a cricothyrotomy, were accessible and ready to use in each operating theatre or location where airway management occurs. The questionnaire also included human factors‐related issues such as: the availability of cognitive aids; whether communication of a CICO emergency was clear and whether the language used to describe a CICO situation was simple and easy to understand; provision of staff training in CICO management and cricothyrotomy; and whether case‐review systems were in place .…”