Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital

Abstract

Objective Study the performance of a pediatric critical airway response team. Study Design Case series with chart review. Setting Freestanding academic children's hospital. Subjects and Methods A structured review of the electronic medical record was conducted for all activations of the critical airway team. Characteristics of the activations and patients are reported using descriptive statistics. Activation of the critical airway team occurred 196 times in 46 months (March 2012 to December 2015); complete data were available for 162 activations (83%). For 49 activations (30%), patients had diagnoses associated with difficult intubation; 45 (28%) had a history of difficult laryngoscopy. Results Activation occurred at least 4 times per month on average (vs 3 per month for hospital-wide codes). The most common reasons for team activation were anticipated difficult intubation (45%) or failed intubation attempt (20%). For 79% of activations, the team performed an airway procedure, most commonly direct laryngoscopy and tracheal intubation. Bronchoscopy was performed in 47% of activations. Surgical airway rescue was attempted 4 times. Cardiopulmonary resuscitation occurred in 41 activations (25%). Twenty-nine patients died during or following team activation (18%), including 10 deaths associated with the critical airway event. Conclusion Critical airway team activation occurred at least once per week on average. Direct laryngoscopy, tracheal intubation, and bronchoscopic procedures were performed frequently; surgical airway rescue was rare. Most patients had existing risk factors for difficult intubation. Given our rate of serious morbidity and mortality, primary prevention of critical airway events will be a focus of future efforts.

Factors Associated With Pediatric Emergency Airway Management by the Difficult Airway Response Team

“…Interestingly, genetic syndromes without craniofacial involvement did not increase the risk for DART intervention, nor did airway bleeding or musculoskeletal diseases. Similar to results published by Sterrett et al [9], we found that intubation by both the DART and RRT occurred throughout all hours of the day and night. Not only must hospitals have RRTs staffed with expert personnel, these teams must also be readily available 24 hours a day.…”

“…Patients with craniofacial abnormalities or airway swelling, or who were 1-2 years old, were significantly more likely to have airway management by the DART in our study than were children without these risk factors. These findings are consistent with previously identified risk factors for difficult airway management in children [3,9,10]. Unexpectedly, active chest compressions were more common during intubations performed by the RRT, suggesting that glottic movement did not contribute to the ease of endotracheal tube placement.…”

Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry

“…In our study, nine patients (i.e., 2.5% of the cases needed intubation by the AC team) required an additional ENT airway call for securing a surgical airway, similar to a report from a 628-bed pediatric hospital (2.5% of 162 activations), 16 but much higher than that of another hospital (0.26% of 3,423 activations). 2 …”

Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management?

“…There were no claims of malpractice, death, or morbidity lodged for adult patients with DART involvement. Programs similar to the DART have now been successfully implemented outside of Johns Hopkins including in pediatric hospitals [54][55][56][57][58].…”