Emergency Airway Research Articles

Practical guidance for monitored anesthesia care during awake craniotomy

Monitored anesthesia care is a feasible option for anesthetic management during awake craniotomy. Patients selected for surgery are thoroughly evaluated by anesthesiologists, primarily focusing on their risk for airway emergencies, such as respiratory depression and obstruction, throughout the procedure. For patients with relative contraindications, a tailored approach is used to assess their suitability. Neuropsychiatric counseling is also helpful for enhancing the patient’s ability to participate in and perform the necessary tasks during brain mapping. Building good rapport with the patient is essential for the success of awake craniotomy, as it helps foster trust and cooperation. Analgesia during awake craniotomy is primarily achieved through scalp nerve blocks or infiltration. Among the six scalp nerve blocks, I have described the zygotemporal nerve block in detail. Proper positioning is crucial for both the surgical approach and the safety and comfort of the patient. Even when local anesthetics are effectively administered, many patients may still experience mild to moderate pain during the procedure. This pain is common and transient, typically occurring around the temporal region. In some cases, sedatives or additional analgesics may be necessary. Serious adverse events can arise, including those that require urgent life-saving interventions or those that interfere with brain mapping and the patient's ability to perform tasks. However, MAC in neurosurgery offers the potential for an improved quality of life for individuals with brain tumors or epileptic seizures, as well as for those with disabilities, such as the deaf or visually impaired, in the future.

Audit of surgical tracheostomy in ICU setting: an institutional study

Background: The aim of the study was to assess the indication, timing of the procedure, immediate, early and late complication of surgical tracheostomy in intensive care unit. Methods: The study was done on patients who are in need for surgical tracheostomy in intensive care unit at MGM Healthcare hospital for a period of 4 years from the year July 2019 to June 2023. All patients were taken up for surgical tracheostomy at the operation theater under monitored anaesthetic care. All patients were followed up for 1 year in the postoperative period. Results: This is a retrospective study, conducted in the Department of ENT, Head and Neck Surgery, A total of 78 patients were taken into study. Among them, the major indication for tracheostomy was the need for prolonged ventilation accounting for 76 patients and diaphragmatic palsy accounting for 2 patients. Early tracheostomy was done for 14 patients within 1-7 days of intubation and late tracheotomy were done for rest 64 patients between 8 to 14 days of intubation. Early Complication like hemorrhage occurred in 7 patient, surgical emphysema in 3 patients. Conclusion: Prolonged intubation is the main indication for surgical tracheostomy, performed after 1 week of intubation. Complications of tracheostomy can be life threatening and should be carefully monitored. Ideally, the procedure performed in operating room results in better outcomes. However, in case of acute airway compromise and emergency situations ICU settings and bed side procedures can avoid morbidity and mortality stand points in post operative period.

Selection of induction agents for safe and effective rapid sequence intubation⁠

Rapid sequence intubation (RSI) is a critical procedure in emergency airway management, requiring rapid induction of unconsciousness and muscle relaxation to facilitate safe intubation. The choice of induction agent plays a pivotal role in optimizing outcomes, as each agent exhibits unique pharmacokinetic and pharmacodynamic profiles. Etomidate is frequently chosen for its hemodynamic stability, making it suitable for critically ill patients; however, concerns regarding adrenal suppression warrant caution in septic or prolonged critical illness cases. Ketamine is particularly advantageous in patients with reactive airway diseases or hypotension, owing to its bronchodilatory effects and ability to preserve respiratory drive, although its psychotomimetic side effects must be managed carefully. Propofol, characterized by its rapid onset and short duration, provides excellent intubating conditions but may cause significant hypotension, limiting its use in hemodynamically unstable patients. Thiopental, once widely used, is now less favored due to cardiovascular depression and prolonged recovery times. Patient-specific factors, including age, comorbidities, and clinical status, heavily influence agent selection. Pediatric and geriatric populations pose unique challenges, necessitating dose adjustments and close monitoring. Emerging agents like dexmedetomidine offer novel benefits such as sedation with preserved respiratory function, though slower onset limits its utility in emergency settings. The complexity of decision-making underscores the importance of understanding the nuances of each agent’s efficacy and safety. Despite advancements in pharmacological options, limitations in evidence, variability in patient responses, and resource constraints highlight the need for individualized approaches and adaptable guidelines. Further research is essential to bridge gaps in knowledge and establish standardized practices to enhance safety and effectiveness in RSI across diverse clinical scenarios.

Tele-mentorship versus in-person mentorship for trainee performance of cricothyroidotomy

Introduction Physicians and other first-line medical care providers may find themselves in an airway management emergency where they cannot ventilate, cannot oxygenate, and have limited resources to aid them. The rise in use of tele-health and other virtual interfaces creates the opportunity to bring experienced guidance to a resource-poor critical airway situation. We aimed to compare in-person mentoring (IPM) by an emergency medicine (EM) physician to tele-mentoring (TM) by a trauma surgeon for an emergent surgical airway. Methods Thirty EM residents were randomized to cricothyroidotomy on a model with IPM or TM. The IPM preceptor was an EM attending, and TM preceptors were trauma surgeons. The procedure was timed and graded on a Global Rating Scale (GRS). Post-procedure, mentor and trainee completed a NASA Task Load Index (TLX). Results There was no difference in procedure success; however, the IPM group took longer (163.6 vs. 107.6 s, p < 0.05). TM trainees experienced greater temporal demand (4.27 vs. 2.73, p = 0.03). Telementors recorded improved performance compared to in-person mentors (2.30 vs. 4.17, p < 0.05). Comparing mentors and trainees in each arm, IPM trainees felt more temporal demand than their mentors (4.63 vs. 2.73, p < 0.05) while TM trainees felt they had worse performance than their mentors perceived (4.23 vs. 2.3, p = 0.01). Discussion Performance based on GRS between groups was equal; however, those with telementors secured the airway more rapidly. Telementors reported higher performance and lower time pressure than in-person preceptors. This data suggests that TM is effective for precepting cricothyroidotomy and may be the superior option in some settings.

Emergency Airway Management: A Systematic Review on the Effectiveness of Cognitive Aids in Improving Outcomes and Provider Performance.

Background/Objectives: Emergency airway management is a critical skill for healthcare professionals, particularly in life-threatening situations like "cannot intubate, cannot oxygenate" (CICO) scenarios. Errors and delays in airway management can lead to adverse outcomes, including hypoxia and death. Cognitive aids, such as checklists and algorithms, have been proposed as tools to improve decision-making, procedural competency, and non-technical skills in these high-stakes environments. This systematic review aims to evaluate the effectiveness of cognitive aids in enhancing emergency airway management skills among health professionals and trainees. Methods: A systematic search of MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov was conducted from February to March 2024. Studies examining the use of cognitive aids, such as the Vortex method, the ASA difficult airway algorithm, and visual airway aids, in emergency airway scenarios were included. Outcomes assessed included decision-making speed, procedural success rates, and non-technical skills. Data were extracted using standardized protocols, and the quality of included studies was appraised. Results: Five studies met inclusion criteria, encompassing randomized controlled trials, controlled studies, and mixed-methods research. Cognitive aids improved decision-making times (reduced by 44.6 s), increased procedural success rates, and enhanced non-technical skills such as teamwork and crisis management. Participants reported reduced anxiety and improved confidence levels (self-efficacy scores increased by 1.9 points). The Vortex method and visual cognitive aids demonstrated particular effectiveness in simulated scenarios. Conclusions: Cognitive aids significantly enhance emergency airway management skills, improving performance, reducing errors, and increasing provider confidence. Integrating cognitive aids into training programs has the potential to improve patient safety and outcomes. Further research is needed to validate these findings in clinical settings and optimize cognitive aid design and implementation.

Prehospital Cricothyrotomy for Emergency Airway Management.

Prehospital Cricothyrotomy for Emergency Airway Management.

Complete expiratory central airway collapse at general anesthesia recovery: a case report.

Expiratory central airway collapse is a degenerative tracheobronchial disease that is often overlooked because of its nonspecific clinical features. A man was admitted for evaluation of tracheal nodules. Following bronchoscopic biopsy, a significant increase in airway pressure occurred during anesthesia recovery. Laryngospasm was suspected, and tracheal intubation was performed. Bronchoscopy revealed an almost completely collapsed tracheal lumen. A Y-shaped silicone stent was placed using a rigid bronchoscope to support the airway, allowing spontaneous ventilation to resume. A retrospective review of the images suggested a diagnosis of excessive dynamic airway collapse. The silicone stent was removed after 2 weeks because of discomfort, and no subsequent dyspnea was observed. This case highlights that excessive dynamic airway collapse is easily missed. Anesthesiologists must be educated on this condition, maintain a thorough understanding of the patient's state and illness, and have emergency airway equipment readily available to restore ventilation promptly in cases of severe airway collapse.

Predictors of Airway Compromise in Patients with Angioedema Presenting to the Emergency Room

Angioedema is characterized by the rapid swelling of the deeper layers of the skin, often affecting the face, lips, tongue, and throat. In emergency settings, airway compromise is a significant concern due to the potential for airway obstruction. Several predictors can aid in identifying patients at higher risk for airway emergencies. These include the duration of the swelling, the involvement of the tongue or oropharynx, associated respiratory symptoms, and a known history of previous angioedema episodes. Rapid progression and the presence of associated symptoms such as dysphagia or stridor may also indicate an increased risk of airway obstruction, warranting immediate intervention. Other key risk factors include the patient's age, underlying health conditions (such as asthma or chronic obstructive pulmonary disease), and any potential triggers, such as medication use or allergic reactions. Past medical history can provide crucial insights; patients with hereditary angioedema or those who have previously experienced severe airway compromise are at greater risk. Clinicians should conduct a thorough assessment, including visual inspection and auscultation of the airway, to anticipate and manage potential complications effectively. Early recognition and timely intervention can significantly improve patient outcomes in these high-risk situations.

전문소생술 시뮬레이션 실습이 간호학생의 학습실재감, 비판적 사고성향, 전문소생술 자기효능감에 미치는 효과

This study aimed to examine the effects of advanced cardiovascular life support simulation practice for nursing students' learning presence, critical thinking disposition and self-efficacy. The research design was single-group pre-post experimental study, and participants were 101 fourth-year nursing students. Data was collected from April 29 to July 7, 2024. A total of 4 teams were formed with 5~6 people per team, The education contents included specialized cardiac compression, airway maintenance device, defibrillator, emergency medication and advanced cardiovascular life support simulation practice. Data were collected using a structured questionnaire, and the collected data was analyzed using SPSS/WIN 25.0 program for descriptive statistics and paired t-test, analyzed with Pearson correlation coefficient. Nursing students experienced greater learning presence, critical thinking disposition, and self-efficacy after practicing advanced life support simulation was statistically significantly improved, and there was a significant positive correlation between variables. The results suggested that advanced cardiovascular life support simulation practice was confirmed as an effective teaching and learning method for nursing students' learning presence, critical thinking disposition and self-efficacy. These findings indicate that advanced cardiovascular life support simulation practice is an effective intervention for improving learning presence, critical thinking disposition and self-efficacy in nursing education. Based on the research results, It is believed that this can be used as basic data for emergency simulation training programs.

Using the Glottic Angle and Area in Cases of Bilateral Vocal Fold Paralysis.

Objective: Establish, through the determination of the glottic angle and area, a decision regarding safe and necessary interventions in bilateral vocal fold paralysis to maintain airway. Methods: From January 2008 to December 2023, we looked back at laryngoscopic photographs of subjects with bilateral vocal fold paralysis. The average vocal fold length for each gender was used to calculate the glottic areas and measure the corresponding glottic angles in a total of 26 cases. In order to determine the angles between the anterior commissure and each vocal process, 2 clinicians separately measured the lines and took their average measurement. The average vocal cord length by gender in the Taiwanese data was used to compute the glottic area. Results: The results showed the average glottic angle was 10.3° ± 7.3°. The intervention group (N = 17) had an average glottic angle of 7.1° ± 3.7°. The nonintervention group (N = 9) had an average glottic angle of 16.3° ± 8.9°. The average glottic area was 18.7 ± 10.2 mm2, with 14.2 ± 7.5 mm2 in the intervention group and 27.2 ± 9. 4 mm2 in the nonintervention group. Conclusion: We concluded that emergent airway intervention including intubation or tracheostomy was suggested when the glottic angle <12.2° or glottic area <25.2 mm2.

Aerodigestoscopy (ADS): The Feasibility, Safety, and Comfort of a Comprehensive Procedure for the Evaluation of Physiological Disorders of the Aerodigestive Tract.

Background: Limited access to the comprehensive assessment of disorders of the upper aerodigestive tract is a barrier to care in rural health facilities. Assessment of the full aerodigestive tract requires a variety of specialists. The inability to access the necessary specialists can result in misdiagnosis, underdiagnosis, and increased associated mortality. Currently, no single differential diagnostic exam comprehensively assesses all functions of the upper aerodigestive tract to bridge this gap. The purpose of this study is to investigate the feasibility and safety of a novel procedure called ADS that can bridge this gap. Methods: Results from 18,464 ADS procedures were retrospectively analyzed for feasibility, safety and comfort. Results: 96.8% of ADS procedures were successfully completed without complication, confirming the efficacy of the procedure. Conclusions: ADS is a single procedure for the assessment of physiological functions of the upper aerodigestive tract, including swallow, voice, respiration, and cough while also screening for impaired gastric retention and obstructive sleep apnea, which may pose additional urgent and emergent airway threats. ADS may improve health outcomes in underserved populations, e.g., those in a rural community, referred to by other health professionals due to complaints of aerodigestive symptoms and signs.

The Role of Telemedicine in Emergency Department Triage and Patient Care: A Systematic Review.

Overcrowding in emergency departments (EDs) is a global challenge, leading to prolonged waiting times and adverse patient outcomes. Telemedicine has emerged as a promising solution, enabling remote consultation, triage, and real-time specialist input. Despite its growing application, limited systematic research exists on its specific role in ED triage and care. This systematic review evaluated the effectiveness of telemedicine interventions in ED settings, focusing on diagnostic accuracy, patient satisfaction, throughput times, and re-admission rates. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted up to November 10, 2024. Eligible studies were randomized controlled trials (RCTs) in English that assessed telemedicine in ED settings. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the modified Downs and Black scale. Six RCTs met the inclusion criteria. Results showed that telemedicine improved diagnostic accuracy, reduced re-consultation rates, and enhanced treatment adherence. High diagnostic concordance with in-person assessments was observed, particularly in non-critical cases. Several studies reported shorter throughput times and higher patient satisfaction with telemedicine compared to traditional care. However, telemedicine's impact on high-acuity cases, such as emergency airway management, was less pronounced. Limitations included small sample sizes and the inability to blind participants, which may have influenced outcomes. Telemedicine holds significant potential to improve ED triage and care in non-critical cases, reducing waiting times and enhancing patient outcomes. Further research is needed to establish its efficacy in high-acuity settings and address challenges related to infrastructure and privacy. Telemedicine should complement in-person care as part of an integrated ED strategy.

National Survey of Airway Management Practices and Training Among Emergency Medicine Residency Programs in the United States.

As airway management becomes more complex with the adoption of new technologies and strategies, it is important to ensure that emergency medicine residents, the future of the specialty, receive extensive training. This study was designed to understand the prevailing airway management practices and training within emergency medicine residency programs. A survey consisting of 19 multiple-choice questions was sent to program directors of 258 emergency medicine residency programs in the United States. A total of 63 emergency medicine residency programs completed the airway survey, a response rate of 24%. Programs from all regions of the country are represented, most of them from university-based teaching hospitals (40%) and 3-year programs (78%). The majority of programs provide their residents with 50-100 intubations (50.8%) during their training. Pediatric intubations remain scarce with 54.1% of programs having only 5-10 pediatric intubations per resident. The emergency medicine team manages 93.6% of all trauma intubations, and residents complete 81% to 100% of all the department's intubations 88.9% of the time. Video laryngoscopy is on the rise, with GlideScope® (93.7%) and C-Mac® (55.6%) being the most common devices available. Overall, programs use both succinylcholine and rocuronium equally, but there is a trend toward using rocuronium more frequently than succinylcholine. By employing different teaching modalities, multiple times a year, residency programs expose residents to a variety of backup tools and surgical airway techniques. Emergency medicine residents are exposed to multiple advanced airway adjuncts and comprehensive airway curriculums as emergency airway management practices evolve and become more complex.

Tracheostomy Tube Monitoring Accessory to Detect Accidental Decannulation and Obstruction Emergencies in Ventilator-Independent Pediatric Patients

Introduction: Some of the leading causes of tracheostomy-related complications in pediatric populations are accidental decannulation and obstruction events that result in permanent neurological damage or death if not mitigated quickly enough. Despite the severity of tracheostomy tube emergency events, there is currently no effective medical technology available that can specifically detect accidental decannulation or obstruction in a tracheostomized patient that is not ventilator dependent. Therefore, a pediatric tracheal breathing model system was developed to assist with testing new tracheostomy tube technologies for identifying emergency events. Methods: A custom carbon dioxide monitoring tracheostomy tube attachment was engineered to collect breathing waveform data during emergency events (e.g., improper insertion, accidental decannulation, and mucus obstruction). Anatomically accurate pediatric tracheal models for various age groups (0-3 months, 2-4 years, and 10-12 years old) were developed with modelling software and a 3D printer. A breathing simulator was integrated with the tracheal models to generate age-dependent respiration patterns during simulated tracheostomy tube emergencies. Results: Carbon dioxide readings from the custom tracheostomy tube attachment indicated distinct waveform recordings during simulated tracheostomy tube emergency events for all age groups tested. During incorrect insertion, accidental decannulation, and complete blockage of a tracheostomy tube, exhaled carbon dioxide readings remained static at ambient levels. Partial mucus obstruction of a tracheostomy tube decreased exhaled carbon dioxide waveform amplitude relative to unobstructed conditions. Conclusions: The tracheostomy tube attachment successfully recorded respiration patterns during simulated tracheostomy tube emergencies in pediatric patients of varying age. Breathing waveform data collected from the model system will aid in the development of emergency airway event detection software integrated in the tracheostomy tube sensing accessory.

Comparing first pass success of Channeled versus Non-channeled KingVision video laryngoscopes in patients presenting to the emergency department – A randomized control study

IntroductionIn modern times, the emergency physician (EP) has access to a host of video laryngoscopes (VL). There are different makes, models, angulations in the blades provided by different VLs. The blades may be channeled or non-channeled. In busy emergency departments (ED), ease and speed of intubations in managing the emergent airways may impact the outcome for the patient. ObjectiveThe primary objective of our study was to compare the rates of first pass success using the channeled versus the non-channeled blades of the KingVision VL (KVVL). MethodsThis was a randomized controlled single blinded study. All patients requiring emergent definitive airway management were included in the study. They were randomized into 2 groups – channeled and non-channeled KVVL. Intubations were carried out accordingly. First pass success, time taken to intubate and crossover between the blades were recorded. ResultsA total of 130 patients were enrolled in the study. First pass success for the channeled and non-channeled KVVL was 55.4 % and 81.6 % (p = 0.005) respectively. The mean time to intubate using the channeled and non-channeled KVVL were 24.69 s [95 % CI 20.25–29.13] and 28.95 s [95 % CI 23.64–34.26] (p = 0.207) respectively. A total of 33.07 % patients had crossovers between the blades. ConclusionWe found the non-channeled blades to have a significantly higher percentage of first pass success. Performance with respect to time to intubate was similar between the two. We recommend using the non-channeled KVVL for intubations in the EDs.

Teaching Airway Management Using Virtual Reality: A Scoping Review

(Anesth Analg. 2024;138(4):782–793. doi: 10.1213/ANE.0000000000006611) Airway management is a term that refers to the safe and effective increase in oxygen provided by ventilation or oxygenation in individuals that are sedated or unconscious, and the procedure is performed only by trained professionals. Training for this skill set is often done on the job, during a residency program for anesthesia or acute care. Recent advances in training environments have allowed for safer skill acquisition through simulations that allow for practice without any possibility of harming a patient, blending the need for supervision from experienced faculty with relevant situations that present no risk. These programs are expensive and labor intensive to implement and maintain; one potential solution to this is virtual reality (VR), which could blend all of the advantages of simulation education without the disadvantages of required faculty presence at all times. The immersive technology can also be implemented to simulate more diverse situations with less effort and allows for assessment of skill and training. This article is a review that evaluates VR as an effective tool for simulation education for both routine and emergency airway management.

Effective blind bilateral superficial cervical plexus block for tracheostomy tube insertion in a geriatric patient with Ludwig angina with hypertension in resource constrained area: a case report

IntroductionLudwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors’ own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.Case presentationWe report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist–Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient’s hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.Clinical discussionProper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.ConclusionManagement of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist’s level of experience, such as performing superficial regional block and good mask ventilation; and the patient’s medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Implementation of Direct Admission to the Operating Room Procedure for Children Transported With Airway Emergencies

ObjectiveChildren with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes. MethodsWe performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using t-test and Mann-Whitney U test. ResultsOf the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (P = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, P < .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, P = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%). ConclusionImplementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.

Integrating the Airway Lead structure into a large healthcare system to appraise the landscape of airway management resources

Airway Leads are clinicians who guide safe airway management institutionally and act as liaisons between the evolving airway management landscape and bedside clinicians. Internationally, resources produced by Airway Leads Networks aid clinicians in establishing emergency airway management protocols and making difficult airway equipment decisions. The creation of an Airway Leads Network within the United States' multi-payer healthcare system is ongoing, spearheaded nationally by groups such as the Society for Airway Management. We aimed to build a committee of airway leaders across the Yale New Haven Health system and to leverage this committee to appraise the airway equipment and personnel resources throughout the system. We identified key stakeholders in airway management across the healthcare system and administered a quality improvement survey to members of the assembled committee querying their knowledge of the availability of airway management devices. The dataset was gathered from 14 airway management leaders identified across 4 surgical facilities, 6 emergency departments and 5 medical intensive care units at 8 hospitals and hospital campuses within the Yale New Haven Health system. Equipment available in greater than 75 % of locations included hyperangulated and standard geometry videolaryngoscopes, rigid tracheal tube stylets, tracheal tube introducers, flexible intubation scopes, scalpels and waveform capnography. Equipment available in 25 % to <75 % of locations included emergency invasive airway kits, wheeled airway towers or airway boxes, intubating oral airways, airway exchange and Aintree catheters, intubation-capable supraglottic airways, and awake intubation supplies. Glidescope (Verathon) was the most common videolaryngoscope and flexible intubation scope, and Aura (Teleflex) was the most common intubation-capable supraglottic airway available. The initiative illustrated the feasibility and utility of developing a committee of airway leaders in a large health system. While all locations had access to a requisite array of airway management devices, there was variation in the availability and brand of individual airway equipment.

The Airway Lead and the Creation of a Comprehensive Emergency Airway Quality Program

BackgroundEmergency Department (ED) Intubation is one of the most critical times during a patient's hospital course. Ideal performance requires training, equipment, and mindset to overcome the barriers of anatomy, physiology, and human factors. ObjectivesWe believe that EDs should use the same model of quality improvement and leadership for intubation as other critical procedures such as ED ultrasound. DiscussionThis paper delineates one program's creation of a comprehensive airway quality improvement (QI) program and will hopefully serve as a roadmap for other centers. ConclusionsThe creation of an airway QI program headed by a designated airway lead has the potential to improve patient care and procedural success in the ED.