Emergency Surgical Airway Success & Failure

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Presentation transcript:

Emergency Surgical Airway Success & Failure NAP4 Emergency Surgical Airway Success & Failure Chris Frerk & Tim Cook

Emergency Surgical Airway 80 people presenting for surgery, being cared for in ITU or coming to the ED ended up with an unplanned hole in the neck in an attempt to rescue a lost airway

At least 7 ended up with ongoing disability 13 of them died

It will happen in your hospital. You may be called urgently to help in the anaesthetic room next door!

There is no one guaranteed “safe technique”

Awake techniques were not used when they should have been

If awake techniques are not in your skillset then seek assistance when presented with difficult cases

Plan A Plan B Plan C Plan D Plan X Even the best plan A may fail – always have clear fallback plans Plan B Plan C Plan A Plan D Plan X

On many occasions LMAs & muscle relaxants were not used to attempt rescue prior to cricothyroidotomy

They should be

Emergency Surgical Airway When all else fails Emergency cric doesn’t always succeed!

63% jet ventilation attempts failed 43% wide bore cannula crics failed In anaesthesia & ED cases all surgical attempts successfully accessed the airway

More often than not we defer to our surgical colleagues to rescue our patients airways

ICU (12 Cases) Emergency surgical airways were needed following: Failed intubation Failed Extubation (planned & unplanned) Continuing deterioration while being observed in a place of safety

ICU (12 Cases) Lack of equipment was a particular problem: Some units had no difficult airway trolley at all Some were missing particular equipment that was required (proseal LMA, fibrescope)

Recommendations Always discuss alternate options for plan A – especially AWAKE options Openly discuss plans B, C & D Use muscle relaxant and LMA early in CICV Learn surgical cricothyroidotomy