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Need for Emergency Surgical Airway Reduced by a Comprehensive Difficult Airway Program

Lauren C. Berkow, MD^*,, Robert S. Greenberg, MD^*,, Kristin H. Kan, BA^*, Elizabeth Colantuoni, PhD^*, Lynette J. Mark, MD^*,, Paul W. Flint, MD, Marco Corridore, MD, Nasir Bhatti, MD, and Eugenie S. Heitmiller, MD^*,

From the Departments of *Anesthesiology/Critical Care Medicine, Otolaryngology, Head and Neck Surgery, and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio.

Address correspondence and reprint requests to Lauren Berkow, MD, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 8-134, Baltimore, MD 21287. Address e-mail to lberkow1{at}jhmi.edu.

Abstract

Background: Inability to intubate and ventilate patients with respiratory failure is associated with significant morbidity and mortality. A patient is considered to have a difficult airway if an anesthesiologist or other health care provider experienced in airway management is unable to ventilate the patient's lungs using bag-mask ventilation and/or is unable to intubate the trachea using direct laryngoscopy.

Methods: We performed a retrospective review of a departmental database to determine whether a comprehensive program to manage difficult airways was associated with a reduced need to secure the airway surgically via cricothyrotomy or tracheostomy. The annual number of unplanned, emergency surgical airway procedures for inability to intubate and ventilate reported for the 4 yr before the program (January 1992 through December 1995) was compared with the annual number reported for the 11 yr after the program was initiated (January 1996 through December 2006).

Results: The number of emergency surgical airways decreased from 6.5 ± 0.5 per year for 4 yr before program initiation to 2.2 ± 0.89 per year for the 11-yr period after program initiation (P < 0.0001). During the 4-yr period from January 1992 through December 1995, 26 surgical airways were reported, whereas only 24 surgical airways were performed in the subsequent 11-yr period (January 1996 through December 2006).

Conclusions: A comprehensive difficult airway program was associated with a reduction in the number of emergency surgical airway procedures performed for the inability of an anesthesiologist to intubate and ventilate, a reduction that was sustained over an 11-yr period. This decrease occurred despite an increase in the number of patients reported to have a difficult airway and an overall increase in the total number of patients receiving anesthesia per year.

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