Abstract 76: A Survey of Airway Skills and Equipment Available During In-Hospital Cardiac Arrest in the United Kingdom

Abstract

Objectives The Resuscitation Council (RC (UK)) recommends that cardiac arrest teams include members skilled in tracheal intubation and provides a list of the equipment that should be available at cardiac arrests. We surveyed intensive care unit (ICU) residents in all general adult ICUs in the UK to determine compliance with these guidelines. The Royal College of Anaesthetists “Initial Assessment of Competency”, normally taken after 3 months of anaesthetic training, was used to define competency in tracheal intubation. Method Using a standardised questionnaire, a resident in each of the 254 general adult ICUs in the UK was surveyed by telephone. Results Responses were obtained from a resident in 192 (76%) of ICUs. ICU residents attended cardiac arrests in 129 (67%) of hospitals; 34% of these residents were not competent in tracheal intubation. Only 124 (65%) of the arrest teams always included a member with at least 6 months anaesthetics experience. Operating department practitioners (anaesthetic assistants) were sole airway operators in 2% of teams. Cardiac arrest airway equipment data was obtained from 181 hospitals (table). Of the 25 cardiac arrest teams not using LMAs, 12 used alternative supraglottic airway devices (SADs). Capnography was routinely available to 22% of arrest teams. Conclusions One third of ICU residents in cardiac arrest teams are not competent in tracheal intubation. Capnography is available to only one fifth of teams. The need for intubation skills at cardiac arrests has been questioned, and may be unnecessary if members of the arrest team are competent in the use of SADs. Capnography is now recommended for confirming intubation at cardiac arrests; it also provides feedback on CPR quality and an early indication of return of spontaneous circulation. All cardiac arrest teams in the UK should have capnography available and implement its use urgently.