Institutional preparedness to prevent and manage anaesthesia-related 'can't intubate, can't oxygenate' events in Australian and New Zealand teaching hospitals.
CICO
airway management; airway emergencies
can't intubate can't oxygenate
Journal
Anaesthesia
ISSN: 1365-2044
Titre abrégé: Anaesthesia
Pays: England
ID NLM: 0370524
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
accepted:
09
10
2019
pubmed:
12
11
2019
medline:
25
6
2020
entrez:
12
11
2019
Statut:
ppublish
Résumé
It is unclear how the recent local and international focus on systems issues and human factors in 'can't intubate, can't oxygenate' events has impacted institutional preparedness in Australia and New Zealand. This study attempts to capture a snapshot of current practices in Australian and New Zealand teaching hospitals with regard to preparedness to prevent and manage 'can't intubate, can't oxygenate' events. All Australian and New Zealand College of Anaesthetists' teaching hospitals were invited to complete an online survey consisting of 33 questions on terminology, equipment, cognitive aids, training and quality assurance. Follow-up was by both email and telephone. Responses were received from 129 (91%) of the 142 sites. The survey revealed both countries have largely moved to point-of-care 'can't intubate, can't oxygenate' equipment. There were regional differences reported, with Australia favouring equipment, cognitive aids and teaching that supports a combined cannula and scalpel approach to 'can't intubate, can't oxygenate', whilst New Zealand favours those promoting a scalpel-only approach. A lack of consistency with the terminology used around 'can't intubate, can't oxygenate' both within and between the two countries was also identified. This survey has revealed a generally reassuringly high degree of institutional preparedness to prevent and manage 'can't intubate, can't oxygenate' events across both countries but with strong regional differences in approaches. Little is known of the institutional practices outside these countries, making international comparison difficult.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
767-774Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Association of Anaesthetists.
Références
Watterson L, Rehak A, Heard A, Marshall S. Transition from supraglottic to infraglottic rescue in the “can't intubate, can't oxygenate” (CICO) scenario. Report from the ANZCA Airway Management Working Group. 2014. http://www.anzca.edu.au/documents/report-from-the-anzca-airway-management-working-gr.pdf (accessed 01/04/2019).
Cook TM, MacDougall-Davis SR. Complications and failure of airway management. British Journal of Anaesthesia 2012; 109(Suppl. 1): i68-85.
Greenland KB, Acott C, Segal R, Goulding G, Riley RH, Merry AF. Emergency surgical airway in life-threatening acute airway emergencies-why are we so reluctant to do it? Anaesthesia and Intensive Care 2011; 39: 578-84.
Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British Journal of Anaesthesia 2011; 106: 617-31.
Weller J, Morris R, Watterson L, et al. Effective management of anaesthetic crises: development and evaluation of a college-accredited simulation-based course for anaesthesia education in Australia and New Zealand. Simulation in Healthcare 2006; 1: 209-14.
Australian and New Zealand College of Anaesthetists. Anaesthesia training program - curriculum. 2018. http://www.anzca.edu.au/documents/anaesthesia-training-program-curriculum.pdf (accessed 09/10/2019).
Australian & New Zealand College of Anaesthetists. Emergency Response Activities. 2018. http://www.anzca.edu.au/fellows/continuing-professional-development/emergency-response-activities (accessed 01/01/2019).
Australian and New Zealand College of Anaesthetists. Standards for Can't Intubate Can't Oxygenate (CICO) education. 2018. http://www.anzca.edu.au/documents/appendix_12_cico_standard_131210.pdf (accessed 01/05/2019).
Watterson L. Preparedness to manage the “can't intubate - can't oxygenate” event. ANZCA Bulletin 2012; 03: 46-9.
Pracy JP, Brennan L, Cook TM, et al. Surgical intervention during a Can't intubate Can't Oxygenate (CICO) event: emergency front-of-neck airway (FONA)? British Journal of Anaesthesia 2016; 117: 426-8.
Royal College of Anaesthetists. Anaesthetists and surgeons reach agreement on front of neck emergency techniques in life-threatening ‘CICO’ situations. 2016. https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/anaesthetists-and-surgeons-reach-agreement-front-of-neck (accessed 01/05/2019).
Cook TM, Woodall N, Frerk C. A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department. British Journal of Anaesthesia 2016; 117: 182-90.
Timmermann A, Chrimes N, Hagberg CA. Need to consider human factors when determining first-line technique for emergency front-of-neck access. British Journal of Anaesthesia 2016; 117: 5-7.
Greenland KB, Bradley WPL, Chapman GA, Goulding G, Irwin MG. Emergency front-of-neck access: scalpel or cannula-and the parable of Buridan's ass. British Journal of Anaesthesia 2017; 118: 811-14.
Australian and New Zealand College of Anaesthetists. CICO and front of neck access. 2017. http://www.anzca.edu.au/front-page-news/cico-and-front-of-neck-access (accessed 01/02/2019).
Australian and New Zealand College of Anaesthetists. Rotations and training sites. 2016. http://www.anzca.edu.au/training/rotations-and-training-sites (accessed 01/04/2017).
Heard AM, Green RJ, Eakins P. The formulation and introduction of a ‘can't intubate, can't ventilate’ algorithm into clinical practice. Anaesthesia 2009; 64: 601-8.
Heard A. Percutaneous emergency oxygenation strategies in the ‘Can't intubate, can't oxygenate’ scenario. Los Gatos, CA: Smashwords Editions, 2013.
Chrimes N, Bradley WPL, Gatward JJ, Weatherall AD. Human factors and the ‘next generation’ airway trolley. Anaesthesia 2019; 74: 427-33.
Schnittker R, Marshall S, Horberry T, Young KL. Human factors enablers and barriers for successful airway management - an in-depth interview study. Anaesthesia 2018; 73: 980-9.
Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia 2015; 115: 827-48.
Lacquiere DA, Hodzovic I, Woollard A, Varvinskiy A, Chishti K, Hughes R. DAS 2015 guidelines for management of CICO. British Journal of Anaesthesia 2016; 117: 532-3.
Baker PA, O'Sullivan EP, Kristensen MS, Lockey D. The great airway debate: is the scalpel mightier than the cannula? British Journal of Anaesthesia 2016; 117(Suppl. 1): i17-19.
Kristensen MS, Teoh WH, Baker PA. Percutaneous emergency airway access; prevention, preparation, technique and training. British Journal of Anaesthesia 2015; 114: 357-61.
Duggan LV, Ballantyne Scott B, Law JA, Morris IR, Murphy MF, Griesdale DE. Transtracheal jet ventilation in the ‘can't intubate can't oxygenate’ emergency: a systematic review. British Journal of Anaesthesia 2016; 117(Suppl. 1): i28-38.
Goldmann K, Ferson DZ. Education and training in airway management. Best Practice Research in Clinical Anaesthesiology 2005; 19: 717-32.
Baker PA, Feinleib J, O'Sullivan EP. Is it time for airway management education to be mandatory? British Journal of Anaesthesia 2016; 117(Suppl. 1): i13-16.
Marshall SD, Chrimes N. Time for a breath of fresh air: rethinking training in airway management. Anaesthesia 2016; 71: 1259-64.
Chrimes N, Cook TM. Critical airways, critical language. British Journal of Anaesthesia 2017; 119: 1072.
Australian Institute of Health and Welfare. Admitted patient care 2017-18: Australian hospital statistics. Canberra. 2019. https://www.aihw.gov.au/reports/hospitals/admitted->patient-care-2017-18/contents/at-a-glance (accessed 09/10/2019).
New Zealand Ministry of Health. Publicly funded hospital discharges - July 2015 to 30 June 2016. 2018. https://www.health.govt.nz/publication/publicly-funded-hospital-discharges-1-July-2015-30-June-2016 (accessed 01/03/2019).
New Zealand Ministry of Health. Privately funded hospital discharges - July 2015 to June 2016. 2018. https://www.health.govt.nz/publication/privately-funded-hospital-discharges-1-July-2015-30-June-2016 (accessed 01/03/2019).