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An obese, 72-year old male comes into the ER experiencing acute respiratory distress. He has a history of obstructive sleep apnea. The patient is suctioned and attempts to provide bag-mask ventilation are unsuccessful. His condition rapidly deteriorates. It becomes evident that intubation is needed, and noting the blue bracelet on the patient’s wrist reading “Difficult to Intubate”, the ER doctor pages the Airway Management Team stat…

What is an Airway Management Team?

More and more across the country, hospitals are establishing Airway Teams to handle difficult airway emergencies, Similar to calling a Code Blue, an Airway Emergency can be initiated, bringing a team of specially trained experts to the bedside to manage the situation. The goal of the Airway Team is to decrease the occurrence of patient morbidity and mortality associated with difficult airway management.

 

Patients who have had difficult intubations in the past, or those with certain physical characteristics- such as advanced age, high BMI, short neck, and small mouth- can be identified with a color-coded wristband or sign at the bedside, indicating that the Airway Team should be called if an emergency arises. However, in the case of an unanticipated difficult airway or unsuccessful intubation attempts, the Airway Team can also be paged for assistance with any patient.

 

Who is on an Airway Management Team?

Team members can vary by hospital, but commonly included are Otolaryngologists, Anesthesiologists and Emergency Medicine Physicians. The team often also includes a dedicated group of nurses, respiratory therapists and technicians.

 

Team members receive specialized training in airway management techniques as developed by the hospital. They have access to and are proficient with utilizing specialized airway management equipment. During training, they also refine their communication skills, which allows them to handle emergencies smoothly and efficiently.

 

What type of equipment to Airway Teams use?

Commonly, Airway Teams will develop their own Airway Emergency Crash Carts and place them in strategic areas of the hospital where respiratory emergencies are most likely to happen, such as the Operating Room, Emergency Room, and Intensive Care Units. These carts are sealed, and after they are opened, they are restocked and resealed. This ensures that needed equipment is always available.

 

Again, what is included in the crash cart can differ between individual hospitals, but as an example, the Anesthesia Patient Safety Foundation’s Fall 2012 newsletter  lists the following as standard equipment in a Florida health care systems Airway Emergency Crash Carts:

 

  • Fiberoptic bronchoscopes
  • Retrograde wire intubation kits
  • Jet ventilators
  • Percutaneous cricothyrotomy kits
  • LMAs
  • Surgical airway equipment and multiple sizes of Shiley tracheostomies
  • Intubation catheters/Bougies
  • Videolaryngoscope
  • Other miscellaneous equipment- This may include a portable suction machine, allowing team members to clear a patient’s airway in any location, or equipment specific to the unit’s demographic, such as pediatric supplies.

 

With this advanced equipment, Airway Team members are often able to successfully intubate difficult airway patients without causing further trauma.

 

Have Airway Management Teams been demonstrating success in the hospital setting?

Yes! Johns Hopkins Hospital has developed a successful Airway Team and responds to emergency calls approximately 8 to 10 times each week, showing that there is a legitimate need for such a team.

 

And in a presentation at the 30th International Symposium on Intensive Care and Emergency Medicine, the Washington Hospital Center Airway Team showed airway establishment time reduced from 55 minutes to 22 minutes and a re-intubation time reduced from 18 minutes to 5 minutes. In addition, there was a decrease in the number of surgical airways that were needed.

 

The number of patients with difficult airways is likely to continue to increase, as things like obesity and longer lifespans also rise. As a result, hospitals should consider the formation of an Airway Management Team so they are equipped to provide the highest level of patient care.

 

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