A novel role for otolaryngologists in the multidisciplinary difficult airway response team

Abstract

Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

“…This situation can arise independent of location (pre-or in-hospital setting), [1][2][3] clinical expertise (medical technician, nurse, or physician), 4,5 or specialty (emergency medicine, anesthesiology, critical care medicine, or surgery). [6][7][8] The most recent American Society of Anesthesiologists' (ASA) "Practice Guidelines for Management of the Difficult Airway" designate surgical or percutaneous airway, jet ventilation, or retrograde intubation as invasive airway access procedures to secure the airway in both non-emergency and emergency situations. 9 Each of these techniques is usually performed at the cricothyroid membrane (CTM).…”

Integration of a Difficult Airway Response Team into a Hospital Emergency Response System

“…These factors include a history of a difficult airway, cervical spine injury or fixation, oropharyngeal and/or supraglottic angioedema, and airway bleeding. A retrospective review of the first 2 years of the DART program and comparison with a non-DART cohort by Hillel and colleagues 29 showed that oropharyngeal and/or supraglottic angioedema patients were 9 times more likely to require a visit to the operating room for management of their difficult airway compared with patients who did not have angioedema. Identification of a patient with a history of a known difficulty airway is frequently done via an alert on the patient's electronic medical record.…”

“…The interaction between multiple specialties builds familiarity and trust that carries over when responding to a difficult airway event in the hospital. 29 It is known that effective teamwork, communication, and coordination among health care providers can aid in preventing adverse patient outcomes. 30 As a result, in recent years there has been a new hospital focus on the multidisciplinary approach to the difficult airway patient.…”

“…Anesthesiologists secured 49 (60%) of the airways during DART calls from 2008 to 2010. 29 Blade laryngoscopy was the primary method used in 39% of cases, followed by videolaryngoscopy at 24% and fiberoptic nasal intubation at 20%. 29 Bag mask ventilation is another vital method that is used to keep the patient ventilating and oxygenated while the airway plan is devised.…”

“…29 Blade laryngoscopy was the primary method used in 39% of cases, followed by videolaryngoscopy at 24% and fiberoptic nasal intubation at 20%. 29 Bag mask ventilation is another vital method that is used to keep the patient ventilating and oxygenated while the airway plan is devised. The anesthesiologist's role is critical to secure the airway and also for the administration of intravenous medications to keep the patient sedated and comfortable.…”