Need for emergency surgical airway reduced by a comprehensive difficult airway program

Lauren C. Berkow, Robert S. Greenberg, Kristin H. Kan, Elizabeth Colantuoni, Lynette J. Mark, Paul Flint, Marco Corridore, Nasir Bhatti, Eugenie S. Heitmiller

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

BACKGROUND: Inability to intubate and ventilate patients with respiratory failure is associated with significant morbidity and mortality. A patient is considered to have a difficult airway if an anesthesiologist or other health care provider experienced in airway management is unable to ventilate the patient's lungs using bag-mask ventilation and/or is unable to intubate the trachea using direct laryngoscopy. METHODS: We performed a retrospective review of a departmental database to determine whether a comprehensive program to manage difficult airways was associated with a reduced need to secure the airway surgically via cricothyrotomy or tracheostomy. The annual number of unplanned, emergency surgical airway procedures for inability to intubate and ventilate reported for the 4 yr before the program (January 1992 through December 1995) was compared with the annual number reported for the 11 yr after the program was initiated (January 1996 through December 2006). RESULTS: The number of emergency surgical airways decreased from 6.5 ± 0.5 per year for 4 yr before program initiation to 2.2 ± 0.89 per year for the 11-yr period after program initiation (P <0.0001). During the 4-yr period from January 1992 through December 1995, 26 surgical airways were reported, whereas only 24 surgical airways were performed in the subsequent 11-yr period (January 1996 through December 2006). CONCLUSIONS: A comprehensive difficult airway program was associated with a reduction in the number of emergency surgical airway procedures performed for the inability of an anesthesiologist to intubate and ventilate, a reduction that was sustained over an 11-yr period. This decrease occurred despite an increase in the number of patients reported to have a difficult airway and an overall increase in the total number of patients receiving anesthesia per year.

Original languageEnglish (US)
Pages (from-to)1860-1869
Number of pages10
JournalAnesthesia and Analgesia
Volume109
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Emergencies
Laryngoscopy
Airway Management
Tracheostomy
Masks
Trachea
Respiratory Insufficiency
Health Personnel
Anesthesia
Databases
Morbidity
Lung
Mortality
Anesthesiologists

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Berkow, L. C., Greenberg, R. S., Kan, K. H., Colantuoni, E., Mark, L. J., Flint, P., ... Heitmiller, E. S. (2009). Need for emergency surgical airway reduced by a comprehensive difficult airway program. Anesthesia and Analgesia, 109(6), 1860-1869. https://doi.org/10.1213/ane.0b013e3181b2531a

Need for emergency surgical airway reduced by a comprehensive difficult airway program. / Berkow, Lauren C.; Greenberg, Robert S.; Kan, Kristin H.; Colantuoni, Elizabeth; Mark, Lynette J.; Flint, Paul; Corridore, Marco; Bhatti, Nasir; Heitmiller, Eugenie S.

In: Anesthesia and Analgesia, Vol. 109, No. 6, 12.2009, p. 1860-1869.

Research output: Contribution to journalArticle

Berkow, LC, Greenberg, RS, Kan, KH, Colantuoni, E, Mark, LJ, Flint, P, Corridore, M, Bhatti, N & Heitmiller, ES 2009, 'Need for emergency surgical airway reduced by a comprehensive difficult airway program', Anesthesia and Analgesia, vol. 109, no. 6, pp. 1860-1869. https://doi.org/10.1213/ane.0b013e3181b2531a
Berkow, Lauren C. ; Greenberg, Robert S. ; Kan, Kristin H. ; Colantuoni, Elizabeth ; Mark, Lynette J. ; Flint, Paul ; Corridore, Marco ; Bhatti, Nasir ; Heitmiller, Eugenie S. / Need for emergency surgical airway reduced by a comprehensive difficult airway program. In: Anesthesia and Analgesia. 2009 ; Vol. 109, No. 6. pp. 1860-1869.
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AU - Mark, Lynette J.

AU - Flint, Paul

AU - Corridore, Marco

AU - Bhatti, Nasir

AU - Heitmiller, Eugenie S.

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N2 - BACKGROUND: Inability to intubate and ventilate patients with respiratory failure is associated with significant morbidity and mortality. A patient is considered to have a difficult airway if an anesthesiologist or other health care provider experienced in airway management is unable to ventilate the patient's lungs using bag-mask ventilation and/or is unable to intubate the trachea using direct laryngoscopy. METHODS: We performed a retrospective review of a departmental database to determine whether a comprehensive program to manage difficult airways was associated with a reduced need to secure the airway surgically via cricothyrotomy or tracheostomy. The annual number of unplanned, emergency surgical airway procedures for inability to intubate and ventilate reported for the 4 yr before the program (January 1992 through December 1995) was compared with the annual number reported for the 11 yr after the program was initiated (January 1996 through December 2006). RESULTS: The number of emergency surgical airways decreased from 6.5 ± 0.5 per year for 4 yr before program initiation to 2.2 ± 0.89 per year for the 11-yr period after program initiation (P <0.0001). During the 4-yr period from January 1992 through December 1995, 26 surgical airways were reported, whereas only 24 surgical airways were performed in the subsequent 11-yr period (January 1996 through December 2006). CONCLUSIONS: A comprehensive difficult airway program was associated with a reduction in the number of emergency surgical airway procedures performed for the inability of an anesthesiologist to intubate and ventilate, a reduction that was sustained over an 11-yr period. This decrease occurred despite an increase in the number of patients reported to have a difficult airway and an overall increase in the total number of patients receiving anesthesia per year.

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