Integration of a Difficult Airway Response Team into a Hospital Emergency Response System

Chmielewska, Monika; Winters, Bradford D.; Pandian, Vinciya; Hillel, Alexander T.

doi:10.1016/j.anclin.2015.02.008

Cited by 9 publications

(8 citation statements)

References 38 publications

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“…Tracheal intubation was the most frequent intervention used by the CCA team to secure a critical airway, as has been corroborated in experiences at other institutions with similar programs. [16][17][18] Adjuncts to tracheal intubation including video laryngoscopy (16.8%), bougie-assisted intubation (0.7%), and fiberoptic bronchoscopy (18.8%), facilitated intubation in patients in whom direct laryngoscopy did not yield an adequate view of the vocal cords. In the remaining cases, a previously placed surgical airway was replaced or, less commonly, a new surgical airway was created.…”

Section: Discussionmentioning

confidence: 99%

Code Critical Airway: A Collaborative Solution to a Catastrophic Problem

Himmler

Mcdermott

Martucci

et al. 2022

The American Surgeon™

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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.

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Section: Discussionmentioning

confidence: 99%

Code Critical Airway: A Collaborative Solution to a Catastrophic Problem

Himmler

Mcdermott

Martucci

et al. 2022

The American Surgeon™

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“…[8][9][10][11][12] In addition, over the last few years, there has been increasing literature regarding ARR team composition. [13][14][15][16] A difficult airway response team has been described by a single institution. 8 This established program has a comparable afferent and efferent limb with a similar patient population by age, sex, and body mass index.…”

Section: Discussionmentioning

confidence: 99%

A surgical needs assessment for airway rapid responses: A retrospective observational study

Hynes

Lambe

Scantling

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Airway rapid response (ARR) teams can be compiled of anesthesiologists, intensivists, otolaryngologists, general and thoracic surgeons, respiratory therapists, and nurses. The optimal composition of an ARR team is unknown but considered to be resource intensive. We sought to determine the type of technical procedures performed during an ARR activation to inform team composition. METHODS:A large urban quaternary academic medical center retrospective review (2016-2019) of adult ARR patients was performed. Analysis included ARR demographics, patient characteristics, characteristics of preexisting tracheostomies, incidence of concomitant conditions, and procedures completed during an ARR event. RESULTS:A total of 345 ARR patients with a median age of 60 years (interquartile range, 47-69 years) and a median time to ARR conclusion of 28 minutes (interquartile range, 14-47 minutes) were included. About 41.7% of the ARR had a preexisting tracheostomy. Overall, there were 130 procedures completed that can be performed by a general surgeon in addition to the 122 difficult intubations. These procedures included recannulation of a tracheostomy, operative intervention, new emergent tracheostomy or cricothyroidotomy, thoracostomy tube placement, initiation of extracorporeal membrane oxygenation, and pericardiocentesis. CONCLUSION:Highly technical procedures are common during an ARR, including procedures related to tracheostomies. Surgeons possess a comprehensive skill set that is unique and comprehensive with respect to airway emergencies. This distinctive skill set creates an important role within the ARR team to perform these urgent technical procedures.

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“…In recent years, there has been a growing emphasis on improved training, decision making, and interdisciplinary collaboration to address the management of patients with difficult airways . To address this need at our institution, a difficult airway response team (DART) was established in 2008 . We hypothesize that a DART utilizing a standardized approach facilitates shorter response time and decreases the number of intubation attempts and surgical airways in patients with advanced oropharyngeal angioedema.…”

Section: Introductionmentioning

confidence: 99%

Management of difficult airway among patients with oropharyngeal angioedema

et al. 2018

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Objective The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. Methods Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre‐DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post‐DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre‐DART and post‐DART cohort. Results The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post‐DART cohort and 56% of the pre‐DART cohort. The incidence of patients requiring intubation was higher in the post‐DART cohort (18 out of 27 [67%]) than the pre‐DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post‐DART and pre‐DART cohorts. Conclusion Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic‐guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. Level of Evidence 3 Laryngoscope, 129:1360–1367, 2019

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Integration of a Difficult Airway Response Team into a Hospital Emergency Response System

Cited by 9 publications

References 38 publications

Code Critical Airway: A Collaborative Solution to a Catastrophic Problem

Code Critical Airway: A Collaborative Solution to a Catastrophic Problem

A surgical needs assessment for airway rapid responses: A retrospective observational study

Management of difficult airway among patients with oropharyngeal angioedema

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