Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study

Ono, Yuko; Tanigawa, Koichi; Shinohara, Kazuhiko; Yano, Toshiaki; Sorimachi, Kotaro; Inokuchi, Ryota; Shimada, Jiro

doi:10.1186/s12245-017-0155-6

Cited by 13 publications

(13 citation statements)

References 58 publications

(61 reference statements)

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“…A nationwide survey on emergency airway management in Japan found that a quantitative capnometry is available to confirm endotracheal tube placement. Interestingly, the same study showed only 47.8% of the EDs routinely use capnometry for this purpose . This might indicate that the lack of familiarity with a capnometry device, not availability, is the main reason of not using capnometry in airway management and in PSA, as shown in our study.…”

Section: Discussionsupporting

confidence: 48%

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

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Section: Discussionsupporting

confidence: 48%

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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“…We believe that, in collaborative efforts between research teams that are adept at generating high‐quality science, such investigations will provide emergency physicians with important opportunities for improving the quality and safety of airway management practice. For researchers and professional organizations, the gained knowledge will not only advance research into the determination of optimal airway management strategies but also facilitate the development of high‐quality clinical guidelines as well as their dissemination to the EDs nationally, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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“…Importantly, to reap the benefits of a well-designed DAT, it is crucial that those who use the DAT are knowledgeable about its organization and have acquired expertise on all included devices through clinical training and simulations. As a dedicated DAT is often present in sites providing general anesthesia, this is not consistently the case according to recent audits and surveys [6, 7]. Importantly, as most airway emergencies develop during the induction phase, incidents can occur throughout the anesthetic process, including extubation [8] and all the way to the postanesthesia care unit.…”

Section: Introductionmentioning

confidence: 99%

The Difficult Airway Trolley: A Narrative Review and Practical Guide

Bjurström

Bodelsson

Sturesson

2019

Anesthesiology Research and Practice

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Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

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Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study

Cited by 13 publications

References 58 publications

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Advancing emergency airway management practice and research

The Difficult Airway Trolley: A Narrative Review and Practical Guide

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