Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

Abstract

This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n=17, 19.1%) or other airway obstruction (n=15, 16.9%). A definitive airway was established by anesthesiology (n=46, 51.7%), emergency medicine (n=25, 28.1%), trauma surgery (n=9, 10.1%), and ENT (n=5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n=29, 32.6%) followed by flexible fiberoptic intubation (n=19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n=4, 4.5%]; tracheostomy [n=4, 4.5%]). Cases were managed in the ED (n=73, 82%), operating room (OR) (n=10, 11.2%), and intensive care unit (ICU) (n=1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.