MP021: Contributing factors and time delays in management of difficult airways in the emergency department - a retrospective analysis. (2nd June 2016)

• Record Type: Journal Article
• Authors: Fernando, S.M.; White, S.; Kwok, E.S.
• Is Part Of: CJEM. Volume 18(2016:Jan.)Supplement 1
• Page Start: S73
• Page End: S73
• Publication Date: 2016-06-02
• Subjects: difficult airway, -- anesthesia, -- quality improvement; Emergency Treatment -- Periodicals; Emergency Medicine -- Periodicals; Emergency medical services -- Canada -- Periodicals; Medical emergencies -- Canada -- Periodicals; Emergency medical services; Medical emergencies; Canada; Periodicals; 616.02505
• DOI: 10.1017/cem.2016.162
• Languages: English
• ISSNs: 1481-8035

Abstract

Abstract : Introduction: Delays in definitive management of difficult airways in the Emergency Department (ED), often involving coordination with expert consultation from Anesthesia and/or Otolaryngology, can lead to devastating outcomes. Currently at our ED there is no standardized approach to identifying and/or managing predicted difficult airway scenarios. We sought to determine the most common factors contributing to predicted difficult airways in the ED, and areas of time delays in securing a definitive airway.Methods: We conducted a retrospective analysis at a tertiary academic centre (>160, 000 ED visits/yr) over a 5 year period. A research assistant screened all cases of "Stat" pages from the ED to the Anesthesia service. An ED clinician performed a thorough review of the charts to confirm difficult airway cases. A single reviewer extracted data on patient demographics, factors associated with a difficult airway, and specific time intervals throughout a patient's clinical course. We present descriptive statistics with 95%CI.Results: 45 cases met our inclusion criteria between Jan 2010-Dec 2014. 16 were excluded and a total of 29 cases of difficulty airways in the ED were included in our final analysis. The average age was 56.7 (95% CI 50.1-63.4) years, and 68.9% were male. The most common factors contributing to difficult airway included: Obesity (48.2%), previous history of head/neck malignancy/radiation (27.6%), and facial edema (20.7%). 25 (86.2%) required expert assistance from Anesthesia/Otolaryngology for definitive airway, and 8 (27.6%) survived to hospital discharge. The mean time between decision to intubate and "Stat" anesthesia page was 14.0 (95% CI 8.7-19.3) mins. The mean time from "Stat" anesthesia page to arrival of anesthesia MD was 8.4 (95% CI 6.0-10.7) mins. The mean time between arrival of anesthesia MD and definitive airway was 12.1 (95% CI 7.4-16.8) mins. The mean time between decision to intubate and definitive airway was 35.5 (95% CI 27.9-43.1) mins.Conclusion: We found a number of common factors contributing to a patient's risk of having a predicted difficult airway in the ED, as well as areas of significant time delays in the unstandardized, multidisciplinary management of these cases. Future work is needed on developing, implementing, and evaluating more standardized difficult airway response protocols in the ED.