Difficult airway update for ODPs: a quality improvement project

Published Date: 12th February 2018

Publication Authors: Jain N, Rodgers K

Management of the difficult airway requires familiarity with equipment and algorithms alongside well-rehearsed skills in their implementation. This demands effective collaboration between anaesthetists, ODPs and others, enabling successful execution of techniques in a crisis. NAP4 identified concerns including lack of education and training, inadequacy of skilled staff or equipment and failure to plan for failure [1]. Updated Difficult Airway Society (DAS) guidance in 2015 [2] provides simple algorithms, but familiarity with this and key equipment may be inadequate among non-anaesthetists.

Methods

We organised teaching for a group of ODPs. Each completed an initial survey assessing levels of confidence in preparing equipment for difficult airways, any previous training and knowledge of current DAS front-of-neck access guidelines. A lecture discussed difficult airway management, DAS guidelines and locations and contents of our difficult airway trolleys. Two practical sessions followed. In one, a fibreoptic scope was set up and used for intubation via a supraglottic airway device, with an Aintree Intubation Catheter (AIC) and manikin. In another, front-of-neck access was demonstrated, using recommended methods both for palpable and impalpable cricothyroid membrane. ODPs then practised these skills, preparing equipment and assisting an anaesthetist. An anonymous post-course survey allowed comparison of confidence levels and understanding.

Results

An absence of formal training was reported by 83.3% (10) for Airtraq preparation, 91.6% (11) for AIC, and by all 12 for fibreoptic scopes. Ten (83.3%) had no tuition on DAS 2015 front-of-neck access guidance. The course increased confidence (Fig. 1). Scores for assisting with AIC and fibreoptic intubation improved from ‘somewhat confident’ at best and ‘not at all confident’ at worst, to between ‘very confident’ and ‘somewhat confident’. Familiarity with DAS guidance was initially poor, but vastly improved. Feedback was extremely positive. Practical workshops were a success; ≥ 90% would recommend them to their peers.

Discussion

Difficult airway management must be rehearsed in non-emergency situations. Inclusive training of all team members improves confidence and familiarity with guidance. We intend to extend this training to all anaesthetic team members in the Trust.

Fadden, E; Rodgers K; Jain, N. (2018). Difficult airway update for ODPs: a quality improvement project. Anaesthesia. 73 (S2), 40.

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