2017-18 HSC Section 3 Green Book

Journal of Intensive Care Medicine

Difficult Airway Management Team AcƟvaƟons (n=266)

Team acƟvaƟons excluded (n=16)

•

Unable to idenƟfy paƟent (n=6)

• No airway intervenƟon documented (n=10)

Difficult Airway Events (n=250)

Airway event categories excluded (n=29)

• •

Tracheostomy related events (n=23) ExisƟng endotracheal tube events (n=6)

NaƟve Airway Events (n=222)

NaƟve airway event locaƟons excluded (N=15)

• •

Emergency Department locaƟon (n=13)

OperaƟng room locaƟon (N=2)

ICU and Hospital NaƟve Airway Events (n=207)

Non-surgical surgical airway events (n=183)

Surgical Airways (n=24)

Surgical airways excluded (n=2)

•

Urgent surgical airway (n=1)

• Deceased paƟent with rigor morƟs (n=1)

Emergency Surgical Airways (n=22)

Figure 1. Difficult airway management team activations culminating in emergency surgical airways performed in intensive care units (ICUs) and hospital units from 2008 to 2012.

imminent. All ESAs except 1 were performed at the patient’s bedside. Cricothyrotomy was the initial ESA method attempted in 20 (91 % ) patients; TRACH was chosen as the initial approach in 2 patients. Unsuccessful CRIC in 2 additional cases necessitated conversion to TRACH (Table 4). Failed CRIC attempts were due to technical failure to pass ETTs and stylettes through the cricothyroid incision in 1 case; in the second, scarring from prior surgical resection and radiation for

cancer combined with a low CRIC incision to frustrate intubation. The majority of ESAs (86 % ) were performed by the trauma/ acute care surgical service; 12 were personally performed by the surgical attending. Emergency surgical airway was success- ful on the first attempt in 14 (64 % ), with more than 1 attempt to cannulate the airway required in the remaining 8 (36 % ) patients. Two patients in this group required a total of 4

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