A novel role for otolaryngologists in the multidisciplinary difficult airway response team

Research output: Contribution to journalArticle

Abstract

Objectives/Hypothesis: The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes. Study Design: Retrospective review of prospectively collected data from the hospital's airway registry. Methods: We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach. Results: Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre-DART implementation to four (0.21%) post-DART implementation. Conclusions: Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.

Original languageEnglish (US)
Pages (from-to)640-644
Number of pages5
JournalLaryngoscope
Volume125
Issue number3
DOIs
StatePublished - Mar 1 2015

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Wounds and Injuries
Laryngoscopes
Angioedema
Airway Management
Otolaryngologists
Registries
Spine
Body Mass Index
Emergencies
Neck
Retrospective Studies
Head
Demography
Anesthesiologists
Surgeons

Keywords

  • Cricothyrotomy
  • Difficult airway
  • Multidisciplinary airway team
  • Oropharyngeal edema
  • Patient outcomes

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Medicine(all)

Cite this

@article{7effa646d402403abe6ad77ef42d3b96,
title = "A novel role for otolaryngologists in the multidisciplinary difficult airway response team",
abstract = "Objectives/Hypothesis: The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes. Study Design: Retrospective review of prospectively collected data from the hospital's airway registry. Methods: We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach. Results: Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60{\%}) patients' airways were secured by anesthesiologists, 30 (36{\%}) by otolaryngologists, and three (4{\%}) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73{\%}) pre-DART implementation to four (0.21{\%}) post-DART implementation. Conclusions: Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.",
keywords = "Cricothyrotomy, Difficult airway, Multidisciplinary airway team, Oropharyngeal edema, Patient outcomes",
author = "Hillel, {Alexander Tell} and Vinciya Pandian and Mark, {Lynette J} and James Clark and Christina Miller and Elliott Haut and Renee Cover and Berkow, {Lauren C.} and Yuri Agrawal and Bhatti, {Nasir Islam}",
year = "2015",
month = "3",
day = "1",
doi = "10.1002/lary.24949",
language = "English (US)",
volume = "125",
pages = "640--644",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",
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T1 - A novel role for otolaryngologists in the multidisciplinary difficult airway response team

AU - Hillel, Alexander Tell

AU - Pandian, Vinciya

AU - Mark, Lynette J

AU - Clark, James

AU - Miller, Christina

AU - Haut, Elliott

AU - Cover, Renee

AU - Berkow, Lauren C.

AU - Agrawal, Yuri

AU - Bhatti, Nasir Islam

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Objectives/Hypothesis: The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes. Study Design: Retrospective review of prospectively collected data from the hospital's airway registry. Methods: We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach. Results: Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre-DART implementation to four (0.21%) post-DART implementation. Conclusions: Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.

AB - Objectives/Hypothesis: The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes. Study Design: Retrospective review of prospectively collected data from the hospital's airway registry. Methods: We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach. Results: Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre-DART implementation to four (0.21%) post-DART implementation. Conclusions: Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.

KW - Cricothyrotomy

KW - Difficult airway

KW - Multidisciplinary airway team

KW - Oropharyngeal edema

KW - Patient outcomes

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