Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study

Offenbacher, Joseph; Nikolla, Dhimitri A.; Carlson, Jestin N.; Smith, Silas W.; Genes, Nicholas; Boatright, Dowin; Brown, Calvin A.

doi:10.1016/j.ajem.2023.02.020

Cited by 7 publications

(14 citation statements)

References 21 publications

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“…Our survival rate is likely lower due to including pre‐hospital surgical airways in our analysis as this group of patients is likely even sicker than patients who had an in‐hospital surgical airway. Overall, we found that the rate of surgical airways encountered in our study is consistent with prior literature on patients undergoing advanced airway procedures in the prehospital and ED setting 4,5 …”

Section: Discussionsupporting

confidence: 88%

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Characteristics and outcomes of prehospital and emergency department surgical airways

Mathews,

McLeod,

Lacy

et al. 2024

JACEP Open

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ObjectivesThe surgical airway is a high acuity, low occurrence procedure. Data on the complications and outcomes of surgical airways are limited. Our primary objective was to describe immediate complications, late complications, and clinical outcomes of patients who underwent a surgical airway procedure in the prehospital or emergency department (ED) setting.MethodsWe conducted a retrospective chart review of patients ≥14 years at an academic medical center who underwent a surgical airway procedure in the ED, the prehospital setting, or at a referring ED prior to interfacility transfer. We identified cases from keyword searches of prehospital text pages and hospital electronic medical records from June 1, 2008 to July 1, 2022. Manual chart review was used to confirm inclusion and determine patient and procedure characteristics. Outcomes included immediate complications, delayed in‐hospital complications, and neurologic disability as defined by Modified Rankin Score (mRS) at discharge.ResultsWe identified 63 patients (34 prehospital, 11 ED, and 18 referring ED). Immediate complications included mainstem intubation (46.0%) and bleeding that required direct pressure (23.4%). Overall, 29 patients (46%) died after arrival to the hospital. Of the patients surviving to hospital admission, 25 (48%) had an airway‐related complication. Nine complications were deemed directly related to technical components of the procedure. Of the patients who survived to discharge, 18 (52.9%) had poor neurologic function (mRS 4–5).ConclusionProcedural complications, mortality, and poor neurologic function were common following a surgical airway procedure in the prehospital or ED setting. Most patients surviving to discharge had a moderate to severe neurologic disability.

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Section: Discussionsupporting

confidence: 88%

“…In the prehospital setting, the incidence of surgical airways is 0.5%–0.7% 4 . The reported rate of surgical airways performed in the emergency department (ED) setting is 0.28%−1.1% 5 …”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of prehospital and emergency department surgical airways

Mathews,

McLeod,

Lacy

et al. 2024

JACEP Open

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“… 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 Of the 69 included studies, there was one randomised controlled trial and 68 observational studies. 10 , 11 , 12 , ...…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of eFONA was described in 53 studies. 42 , 45 , 46 , 54 , 65 , 69 , 72 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 48 , 49 , 50 , 51 , 56 , 57 , 58 , 60 , 61 , 62 , 74 , 75 , 76 , 77 , 78 Studies were conducted across the pre-hospital setting ( n = 23, 43%), in-hospital setting ( n = 13, 25%), pre-hospital/in-hospital setting ( n = 8, 15%), and on the battlefield ( n = 9, 17%). There were important differences in the denominator used to calculate incidence across studies, including all EMS calls, patients in whom tracheal intubation was attempted, and undefined population types ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Emergency front-of-neck access in cardiac arrest: A scoping review

Aljanoubi,

Almazrua,

Johnson

et al. 2024

Resuscitation Plus

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“…1 Although CICO is a rare scenario, it often causes hypoxic brain damage and death if not managed properly. [1][2][3] For the successful management of CICO cases, all major guidelines on difficult airway management recommend immediate invasive airway interventions. 1,4,5 The most commonly used emergency invasive airway technique is cricothyrotomy, 2,3 in which a tracheal tube with a small diameter is placed into the cricothyroid membrane (CTM), located between the thyroid and cricoid cartilages, by making an incision.…”

Section: Introductionmentioning

confidence: 99%

Determination of the Cricothyroid Membrane Height by Age and Sex and Optimal Tracheal Tube Size

Kokulu,

Alkan,

Sert

et al. 2023

The Laryngoscope

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ObjectivesThe primary aim of this study was to determine the average cricothyroid membrane (CTM) height in healthy volunteers, and the secondary aim was to determine the hypothetical success rate for emergency cricothyrotomy with a tracheal tube with an 8.0 mm outer diameter.MethodsThis study included healthy volunteers aged 18 years and older. The participants' clinical characteristics were recorded, and their CTM height was measured using ultrasound, with their necks placed sequentially in the neutral and extension positions. The relationship between the CTM height and sex, age, height, weight, body mass index, and sternomental distance was evaluated using linear regression analysis. An equation that could estimate the height of the CTM was obtained with the parameters found significant in this analysis.ResultsOf the 340 participants, 208 (61.2%) were male. The mean (SD) height of the CTM in the extension position was 9.60 (1.54) mm, and it was significantly shorter in the women than in the men (8.72 [1.19] mm vs. 10.16 [1.48] mm, p < 0.001). Among the participants of short stature, the CTM was significantly shorter, regardless of sex. The hypothetical success rate for emergency cricothyrotomy was 93.3% for the males and 73.5% for the females. The equation for estimating the height of the CTM in the extension position was determined as −4.36 + 5.27 × height (m) + 0.32 × sternomental distance (cm).ConclusionsSince the CTM height may differ according to age, sex, and height, cricothyrotomy sets should be available in various outer diameters.Level of EvidenceN/A Laryngoscope, 2023

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Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study

Cited by 7 publications

References 21 publications

Characteristics and outcomes of prehospital and emergency department surgical airways

Characteristics and outcomes of prehospital and emergency department surgical airways

Emergency front-of-neck access in cardiac arrest: A scoping review

Determination of the Cricothyroid Membrane Height by Age and Sex and Optimal Tracheal Tube Size

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