A novel role for otolaryngologists in the multidisciplinary difficult airway response team. (24th September 2014)

• Record Type: Journal Article
• Authors: Hillel, Alexander T.; Pandian, Vinciya; Mark, Lynette J.; Clark, James; Miller, Christina R.; Haut, Elliott R.; Cover, Renee; Berkow, Lauren C.; Agrawal, Yuri; Bhatti, Nasir
• Is Part Of: Laryngoscope. Volume 125:Number 3(2015:Mar.)
• Page Start: 640
• Page End: 644
• Publication Date: 2014-09-24
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24949
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24949-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes.</p> </sec> <sec id="lary24949-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective review of prospectively collected data from the hospital's airway registry.</p> </sec> <sec id="lary24949-sec-0003" sec-type="section"> <title>Methods</title> <p>We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre‐ and post‐DART cohorts and between DART and non‐DART patients using a matched case‐control approach.</p> </sec> <sec id="lary24949-sec-0004" sec-type="section"> <title>Results</title> <p>Of the 2, 826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty‐nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre‐DART implementation to four (0.21%) post‐DART implementation.</p> </sec> <sec id="lary24949-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.</p> </sec> <sec id="lary24949-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>2b <italic>Laryngoscope</italic>, 125:640–644, 2015</p> </sec> </abstract>