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 response team stat…
What is an Airway Response Team?
More and more across the country, hospitals are establishing airway response 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 response 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 response team should be called if an emergency arises. However, in the case of an unanticipated difficult airway or unsuccessful intubation attempts, the team can also be paged for assistance with any patient.
Who is on an Airway Response 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.
These professionals receive specialized training in airway management techniques 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 Do 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.
What is included in the crash cart can differ between individual hospitals, but as an example, standard equipment should include:
- Equipment for mechanical (bag-mask or EGD) ventilation
- Adjuncts to direct and indirect laryngoscopy such as tracheal introducers
- Direct laryngoscopy alternatives such as video-laryngoscopes and light wands
- A cricothyrotomy kit to facilitate trans tracheal access
- Light sources, cameras, and monitors for techniques either requiring, or facilitated by this equipment;
- Drugs and equipment to apply topical airway anesthesia or airway blocks
- Other miscellaneous equipment that should 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 response team members can often successfully intubate difficult airway patients without causing further trauma.
The Success of Airway Response Teams in the Hospital Setting
The pandemic brought unprecedented numbers of patients with acute respiratory distress to hospital systems, and that required rapid adaptation to respond to the increased demand for airway management.
Massachusetts General Hospital used airway response teams to great success. In reporting their results from March 10, 2020, through May 26, 2020, the hospital stated:
- There were 619 airway consults, and the airway response team performed 341 intubations
- There was a 4-fold increase in intubations, but there was no increase in cardiac arrests or surgical airways and no documented COVID-19 infections among the airway team.
They further stated that their system-level approach successfully met the sudden escalation in demand for airway management. This approach, they said, addressed staffing needs, prioritized provider protection, and enhanced the quality of care.
In addition, a study showed airway establishment time was reduced from 55 to 22 minutes and re-intubation time from 18 to 5 minutes. In addition, there was a decrease in the number of surgical airways needed.
You never know when a difficult airway will present. This means hospitals should consider adding an airway response team with the right equipment to offer a high level of patient care.
Editor's Note: This blog was originally published in November, 2015. It has been re-published with additional up to date content.