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Evidence-based Practice and Quality Improvement

Airway emergencies beyond theatres-on wards and onwards


Mir, F.; McPherson, K.; Ng, K. C.; Patel, A.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 14-14
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Background and Goal of Study: The NAP 4 looked at airway emergencies outside theatres and the contributing factors. Patients presenting in the emergency department are managed by multidisciplinary teams. However, patients on the wards are managed by ENT teams or crash teams for any airway emergency.

The wards may not be adequately equipped to deal with airway catastrophes which is likely to contribute to morbidity and mortality. In the United States1 0.5% of emergency intubations required a surgical airway (the National Emergency Airway

Registry(NEAR). In a study in Scotland2 8.5% of those who had emergency intubations outside theatres had a Cormack and Lehane grade of 3-4. This necessitates regular training of staff and also a robust system of clinical governance and audit to ensure provision of appropriate equipment on wards for these emergencies. A national survey in 20063 made recommendations for an Oxford box with equipment on ENT wards for airway emergencies.

We performed a survey to identify emergency airway equipment available on ENT wards and staff training on its use.

Materials and Methods: A telephone national survey was conducted across all acute trusts (164) in England and Wales.

Results and Discussion: 127 hospitals had inpatient ENT wards and were included in the survey. The Nurse in charge on each ENT ward was called. The response rate was 93%(118). 59%(75) had an airway tray or trolley. This included dedicated airway trolley or tray set up for patients with tracheostomies or post airway surgery. All wards had an allocated person for regular checks of the trolley.The contents of the trolley vary widely and only in 7.8% (10) of the wards the contents comply with the recommendations made for the Oxford box.

In 7 % (9), the first port of call is the anaesthetist for any airway emergencies. In 52.7% (67) cardiac arrest team and in 29.9% (38) ENT teams are called first to manage any airway emergencies on the wards.

In 48% (61) there is no formal training for nursing staff for tracheostomy care.12.5% (16) provide regular training sessions for the nursing staff. In 9 % (12) formal training is given on induction but is not followed by regular sessions. In the remaining 19.6% (25) training is infrequent or once every 1-2 years.

Conclusion(s): Robust guidelines for standardisation of emergency airway equipment on the wards are needed. Nursing staff should have regular training in routine tracheostomy care and airway emergencies.

© 2013 European Society of Anaesthesiology