Airway management outside the operating room: how to better prepare

Abstract

Airway management outside the operating room is associated with increased risks compared with airway management inside the operating room. Moreover, airway management-whether in the intensive care unit, emergency department, interventional radiology suite, or general wards-often requires mastery of not only the anatomically difficult airway but also the physiologically and situationally difficult airway. The 2015 Difficult Airway Society Guidelines encourage the airway team to ''stop and think''. This article provides a practical review of how that evidence applies during emergency airway management outside of the operating room. To counter the challenges of airway management outside the operating room, we offer a mnemonic that combines both technical and non-technical insights summarized using the seven letters of the word PREPARE (P: pre-oxygenate/position; R: reset/resist; E: examine/explicit; P: plan A/B; A: adjust/ attention; R: remain/review; E: exit/explore). We hope it can unite potentially disparate personnel with a structure that allows them to make acute decisions, coordinate action, and communicate unequivocally. This multidisciplinary publication also hopes to encourage common understanding and language between anesthesiologists and non-anesthesiologists about the perils of airway management outside the operating room and the importance of airway teamwork.Résumé La gestion des voies aériennes en dehors de la salle d'opération est associée à une augmentation des risques, comparativement à leur gestion à l'intérieur de la salle d'opération. De plus, la gestion des voies aériennes -que ce soit en unité de soins intensifs, aux urgences, dans une unité de radiologie interventionnelle ou dans un service général -nécessite souvent une maîtrise face, tout d'abord, aux voies aériennes compliquées sur le plan anatomique, mais aussi face aux voies aériennes difficiles à gérer sur le plan physiologique et en situation. Les lignes directrices 2015 de la DAS (Difficult Airway Society) encouragent l'équipe de prise en charge des voies aériennes à « faire une pause et réfléchir ». Cet article fournit une synthèse pratique de l'application des données probantes au cours de la gestion des voies aériennes en urgence, en dehors de la salle d'opération. Pour faire face aux défis de la gestion des voies aériennes en dehors de la salle d'opération, nous proposons un moyen mnémotechnique qui combine des points techniques et non techniques, résumés dans les sept lettres du mot PRÉ PARE (P : préoxygéner/position; R : reprendre/ résister; E : examiner/expliquer; P : plan A/plan B; A : adapter/attention; R : rester/revoir; E : explorer/quitter). Nous espérons que cela peut rassembler des personnels potentiellement disparates dans une structure qui leur permette de prendre des décisions, coordonner leurs

Utility of the laryngeal handshake method for identifying the cricothyroid membrane

“…The laryngeal handshake method is recommended in the Difficult Airway Society 2015 guidelines as a tool for identifying the cricothyroid membrane . Although the laryngeal handshake method has been described in the literature for identifying the cricothyroid membrane, there has been no clinical data regarding the accuracy of the laryngeal handshake method in identifying the cricothyroid membrane . Our results are the first clinical data regarding the use of laryngeal handshake method compared to simple palpation or any other method used in identifying the cricothyroid membrane.…”

Difficult airway management algorithms: a directed review

“…Algorithms published by DAS were the most commonly included, with DAS 2015 (n = 16, 29%) and DAS 2004 (n = 13, 24%) being the most referred to algorithm within the included articles. This was followed by algorithms published by the ASA, with ASA 1993 being referred to in 13 (24%) of the included papers . Moreover, ASA 2013 was referred to in a further 11 (20%) of the included papers .…”

Emergency intubation of children outside of the operating room

“…Situationally difficult airway refers to the human factors that contribute to difficult airway management. These include teamwork, equipment, ergonomics, organization, and culture …”