Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia

Abstract

Although these data suggest the incidence of death and brain damage from airway management during general anaesthesia is low, statistical analysis of the distribution of reports suggests as few as 25% of relevant incidents may have been reported. It therefore provides an indication of the lower limit for incidence of such complications. The review of airway management indicates that in a majority of cases, there is 'room for improvement'.

Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial

“…We chose not to provide this option because of its inefficiency and high failure rate in patients and animal models. 15,17 In summary, subjecting junior anesthesia residents to hands-on training in cricothyrotomy technical skills decreased deviations from the ASA-DAA airway algorithm in a simulated CICO scenario. It did not appear to affect non-technical behaviours, however, including decision making.…”

“…A plausible explanation for this finding is that rating the four skill categories using ANTS may not have the granularity to capture specific non-technical behaviours. 15 The four behavioural categories were subdivided into 15 element behaviours (Appendix). Rating the element behaviours of 'providing and maintaining standards' and 'balancing risks and selecting options' under 'decisionmaking' may have better captured differences in specific non-technical behaviours between the groups.…”

“…Indeed, the Fourth National Audit Project on airway complications in anesthesia emphasized the importance of cricothyrotomy technical skill and non-technical behaviours when managing CICO situations. 15 The purpose of this randomized controlled study was to determine whether training in cricothyrotomy technical skill has an impact on adherence to the ASA difficult airway algorithm (ASA-DAA) and non-technical behaviours. We hypothesized that hands-on cricothyrotomy training would enhance adherence to the ASA-DAA as a result of improved decision-making.…”

Use of a nerve stimulator to assist cricothyroid membrane puncture during difficult airway topicalization

“…1 The Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society also reported a failure rate of 40-65% for needle cricothyroidotomy in emergency situations. 2 Since this procedure is rarely performed, most emergency personnel have either limited or no experience with needle cricothyroidotomy. Factors contributing to high failure rates not only include operator inexperience but also involve the time pressure of an emergency situation.…”

Rapid-sequence induction of anesthesia in obstetric women: how safe is it?

“…Until recently, the incidence, consequences, and causes of the problems had not been that clear, as there have been only reports of analysis of litigation, retrospective series, or prospective studies of a limited area [5]. Recently, the 4th National Audit Project (NAP4) of the Royal College of Anaesthetists and the Difficult Airway Society examined prospectively the occurrence of serious airway complications (resulting in death, brain damage, surgical airway, or unexpected ICU admission) during anesthesia, at all the National Health Service (NHS) hospitals in the UK [6]. This report represents the most definitive source of information on serious airway complications in the UK and provides the most useful data to the world.…”