Unanticipated Difficult Airway Management in the Prehospital Emergency Setting

Combes, X.; Jabre, P.; Margenet, A.; Merle, Jean Claude; Leroux, B.; Dru, M.; Lecarpentier, Éric; Dhonneur, Gilles

doi:10.1097/aln.0b013e318201c42e

Cited by 120 publications

(91 citation statements)

References 22 publications

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“…36 More recently, in a retrospective study of 822 emergent intubations, even the enthusiastic team of Sakles et al reported equivalent overall success rates with use of the GVL vs DL (84% vs 86%, respectively). 37 Moreover, other authors have found a very high success rate of airway management by skilled operators outside the OR without 38 or with very infrequent use of VLs. 28,38,39 Despite the rapidly growing use of VLs in the ED and ICU, there is still no evidencebased paradigm where primary airway management outside the OR, particularly endotracheal intubation, relies mainly on video-laryngoscopy.…”

Section: Etiologies Of Airway Complications Outside the Ormentioning

confidence: 99%

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Paolini

Donati

Drolet

2012

Can J Anesth/J Can Anesth

162

149

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Background An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Principal findings Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety.

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Section: Etiologies Of Airway Complications Outside the Ormentioning

confidence: 99%

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Paolini

Donati

Drolet

2012

Can J Anesth/J Can Anesth

162

149

View full text Add to dashboard Cite

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“…Several SADs are now included in these recommendations and in guidelines for out-ofhospital airway management, not only for management of difficult intubation but as a primary approach for those who do not perform tracheal intubation regularly [85][86][87].…”

Section: Intubation Through a Sadmentioning

confidence: 99%

Supraglottic airways in difficult airway management: successes, failures, use and misuse

Timmermann

2011

Anaesthesia

168

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SummarySupraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre‐hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously.

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“…In this study, there were also two cases of failed ETI with standard techniques using direct and indirect laryngoscopes, which were salvaged by endoscope-guided ETI through iLMA. Several reports have described the usefulness of ventilation and intubation with iLMA [11][12][13][14], a point emphasized in the ASA-DAM guidelines [1].…”

Section: Discussionmentioning

confidence: 99%

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

Ono¹,

Yokoyama²,

Matsumoto³

et al. 2013

J Anesth

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Purpose Airway management of trauma patients during emergency surgeries can be very difficult, and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. MethodsWe performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, and focused on ESA.Results During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5%) required emergency surgery. Four of these (0.72%) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and one patient with penetrating neck trauma received open standard tracheostomies (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes.Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale ≥ 3) received ESA at a significantly higher rate than others (p=0.015, Odds ratio: 14.1). ConclusionOne of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including 3 providing ESA, to assure patient safety.4

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Unanticipated Difficult Airway Management in the Prehospital Emergency Setting

Cited by 120 publications

References 22 publications

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Supraglottic airways in difficult airway management: successes, failures, use and misuse

Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan

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