A Novel Difficult-Airway Prediction Tool for Emergency Airway Management: Validation of the HEAVEN Criteria in a Large Air Medical Cohort

Patients frequently require airway management during rapid response team (RRT) activations. Airway management during RRT activations frequently occurs in locations that are not well equipped or prepared to perform airway procedures. Therefore, it is important that RRTs arrive with the proper equipment and medications to safely secure the airway whenever necessary. An “airway bag” that is stocked by a hospital’s central supply department and carried by RRTs ensures the availability of functioning equipment and helps to standardize the process of airway management during RRT activation. In this chapter, we will review recommendations for equipment required in emergency airway management, including portable routine and difficult airway equipment and medications.

Download Full-text

Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand

BMC Emergency Medicine ◽

10.1186/s12873-021-00434-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jutamas Saoraya ◽

Komsanti Vongkulbhisal ◽

Norawit Kijpaisalratana ◽

Suthaporn Lumlertgul ◽

Khrongwong Musikatavorn ◽

...

Keyword(s):

Emergency Department ◽

Airway Management ◽

Difficult Airway ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Emergency Airway Management ◽

Emergency Airway ◽

Blocking Agents ◽

Glottic View ◽

First Pass

Abstract Background It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department. Methods We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored. Results During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view. Conclusions In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.

Download Full-text

Factors Associated With Pediatric Emergency Airway Management by the Difficult Airway Response Team

Cureus ◽

10.7759/cureus.16118 ◽

2021 ◽

Author(s):

Nicholas M Dalesio ◽

Lauren Burgunder ◽

Natalia M Diaz-Rodriguez ◽

Sara I Jones ◽

Jordan Duval-Arnould ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Pediatric Emergency ◽

Factors Associated ◽

Emergency Airway Management ◽

Emergency Airway ◽

Response Team ◽

Airway Response

Download Full-text

Airway Management In The Emergency Department

10.2310/em.4720 ◽

2018 ◽

Author(s):

Garrett S. Pacheco ◽

Bryan Wilson

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Rapid Sequence Intubation ◽

Intubation Attempt ◽

Emergency Airway Management ◽

Emergency Airway ◽

Airway Emergency ◽

Rapid Sequence ◽

First Pass ◽

Surgical Airway

Emergency airway management has evolved tremendously since the onset of the specialty’s origin. Over the years, the importance of first-pass success and approach to the difficult airway were the primary challenges faced by emergency physicians. With the advent of video laryngoscopy, the rates of first-pass success continue to increase, and the effect of the anatomically difficult airway has begun to lessen. With advances in tools for airway management, the challenges have shifted to approaching optimal preoxygenation and correction of physiologic disturbances prior to any intubation attempt. This review discusses traditional rapid sequence intubation and advances in the field of emergency airway management. This review contains 6 figures, 6 tables and 74 references Key words: difficult airway, emergency airway management, preoxygenation, surgical airway

Download Full-text

Emergency airway management in a Singapore centre: A registry study

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020331 ◽

2021 ◽

Vol 50 (1) ◽

pp. 42-51

Author(s):

Gene Wai Han Chan ◽

Chew Yian Chai ◽

Joy Su-Yue Teo ◽

Calvin Kai En Tjio ◽

Mui Teng Chua ◽

...

Keyword(s):

Adverse Events ◽

Airway Management ◽

Difficult Airway ◽

Rapid Sequence Induction ◽

University Hospital ◽

Rapid Sequence Intubation ◽

Emergency Airway Management ◽

Emergency Airway ◽

Rapid Sequence ◽

Medical Indications

ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567/669). Emergency physicians’ initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75/669) and hypotension (3.7%, 25/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450/669) and the device used was most frequently a video laryngoscope (75.6%, 506/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction

Download Full-text