Emergency front‐of‐neck airway by ENT surgeons and residents: A dutch national survey

Abstract

ObjectivesENT surgeons and anesthesiologists work closely together in managing challenging airway cases. Sharing knowledge, experiences, and expectations interdisciplinary is essential in order to facilitate decision‐making and adequate management in emergency front‐of‐neck airway cases.MethodsA survey was performed, to analyze level of experience, technique of preference, training, knowledge of material and protocols, and self‐efficacy scores of Dutch ENT surgeons and residents in performing an urgent or emergency front‐of‐neck airway.ResultsWithin one year (January 2014–2015), 25.7% of the 257 respondents had performed an urgent or emergency front‐of‐neck airway. Of all reported emergency front‐of‐neck airways (N = 30), 80% were managed by tracheotomy. In future emergency front‐of‐neck airway cases, 74% stated cricothyrotomy would be their technique of preference. The majority would choose an uncuffed large‐bore cannula technique. Post‐academic hands‐on training was attended by 42% of respondents. Self‐efficacy scores were highest for surgical tracheotomy, and higher when trained or experienced. In case of an emergency scenario, 8.6% would not perform a front‐of‐neck airway themselves. The main reasons for reluctance to start in general were lack of experience and lack of training. Reported items for improvement were mainly the development of a protocol and training.ConclusionThe chance of encountering an airway emergency scenario requiring front‐of‐neck airway is realistic. There is inconsistency between advised technique, technique of preference and technique actually performed by ENT surgeons. This study shows that there is both a need and desire for improvement in training and organization of care. Interdisciplinary guidelines and education is needed and could eventually safe lives.Level of evidence5

Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise

“…2 In both urgent and emergency cases, ENT surgeons and anesthesiologists frequently collaborate to perform surgeries. 3 When there is any respiratory difficulty for an unconscious patient, mechanical ventilation is to be established by the intensive care doctors. 4 If the intubation fails, it can result in catastrophic damage to patients, including brain damage or death.…”

“… 12 However, there is no gold standard for a difficult airway algorithm. 3 The primary objective of the present study is to compare and evaluate all three methods in terms of indications, duration of operating time, intraoperative and postoperative complications, and the instruments needed for each procedure.…”