Availability and organization of difficult airway equipment in Swedish hospitals: A national survey of anaesthesiologists

Abstract

Background: Airway complications account for almost one third of anaesthesiarelated brain damage and death. Immediate access to equipment enabling rescue airway strategies is crucial for successful management of unanticipated difficult airway situations. Methods:We conducted a nationwide survey of Swedish anaesthesiologists to analyse availability and organization of difficult airway trolleys (DATs), and multiple factors pertaining to difficult airway management, to highlight areas of potential improvement. Results: Six hundred and thirty-nine anaesthesiologists completed the 14-item survey. Whereas DATs were almost ubiquitous (95%) in main operating departments of hospitals, prevalence was low in remote anaesthetizing locations (20.3%) and electroconvulsive therapy units (26.6%). Approximately 60% of emergency departments had a DAT. Immediate (within 60 seconds) access to videolaryngoscopes in all units where general anaesthesia is conducted was reported by 56.8%. Almost half of anaesthesiologists reported that all DATs at their workplace were standardized. Forty-six per cent reported that the DATs were organized according to a difficult airway algorithm; almost 90% believe that such an organization can impact the outcome of a difficult airway situation positively. Only 36.2% of DATs contained second-generation supraglottic airway devices exclusively. Most Swedish anaesthesiologists use the Swedish Society of Anaesthesiology and Intensive care Medicine difficult airway algorithm, but almost one fifth prefer the Difficult Airway Society algorithm. Less than half of respondents underwent formal difficult airway training annually. Conclusion: Our results motivate efforts to (a) increase availability of DATs in remote anaesthetizing locations, (b) increasingly standardize DATs and organize DATs according to airway algorithms, and (c) increase the frequency of difficult airway training.

Influence of airway trolley organization on efficiency and team performance: A randomized, crossover simulation study

“…Recurrent training to maintain and develop preparedness and nontechnical skills is essential for successful emergency airway management 11 . Although NAP4 has led to increases in the frequency of human factors training and multidisciplinary team training, 35 national surveys commonly show low rates of airway simulation training 16,19 . Simulation‐based airway training may improve adherence to difficult airway algorithms, and increase proficiency in rarely used technical skills 36 .…”

“…By contrast, prior studies have shown deficiencies in practice of airway management techniques, 17,18 as well as lack of simulation training 19 . Less than half of Swedish anesthesiologists report undergoing team‐based difficult airway training annually 16 . Moreover, practice involving DATs is uncommon, 20 and surveys indicate that knowledge of the contents of DATs may be low 21 …”

“…Comprehensive training, to develop and maintain both technical and nontechnical airway management skills, is mandated universally by airway societies throughout the world 12,16 . By contrast, prior studies have shown deficiencies in practice of airway management techniques, 17,18 as well as lack of simulation training 19 .…”

“…The algorithm‐based DAT was created according to findings from a recent critical review of DAT organization and design, including features such as limited range of equipment (“less‐is‐more” concept), clearer links between devices and airway strategy, and integration of cognitive aids to enhance decision‐making and prompt sequential execution of airway management strategies 14 . Almost 90% of Swedish anesthesiologists believe that a DAT design which promotes adherence to difficult airway algorithms might improve outcomes in clinical real‐life airway emergencies 16 . Benefits associated with specific DAT designs may have implications for reduction of morbidity and mortality related to difficult airway management.…”

The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists to analyze current clinical practice and review the training system in the Russian Federation. Review

“…В опросе участникам предлагается ответить на вопросы, освещающие все аспекты проблемы поддержания проходимости ВДП в стационаре. Содержание опроса соответствует структуре проводимых ранее анкетных опросов врачей анестезиологов-реаниматологов РФ в рамках работы Комитета ФАР по ТДП, а также различным зарубежным исследованиям, посвященным всестороннему изучению вопросов поддержания проходимости ВДП [6,[12][13][14][15][16][17]. Анализируются профессиональный стаж, место работы и объем практической работы респондентов, их первичное образование по специальности, объем и характер полученной во время обучения базовой информации по проблеме ТДП.…”