01.07.2017 | Correspondence
Effects of training on resident physician emergency airway management skills
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 7/2017
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Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1‐3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1‐3
Total cohort (n = 218)
|
First attempt by training level
|
First attempt by training specialty
|
|||
---|---|---|---|---|---|
Parameter
|
n (%)
|
PGY 1 (n = 37)
|
PGY ≥2 (n = 181)
|
Non-anesthesiology (n = 122)
|
Anesthesiology (n = 96)
|
Age, mean (SD)
|
66.0 (14.9)
|
67.5 (15.9)
|
65.7 (14.8)
|
66.0 (15.5)
|
66.1 (14.3)
|
Female sex
|
107 (49%)
|
17 (46%)
|
90 (50%)
|
61 (50%)
|
46 (48%)
|
Reason for intubation
|
|||||
Cardiac arrest
|
139 (64%)
|
17 (46%)
|
122 (67%)
|
57 (47%)
|
82 (86%)
|
Respiratory failure
|
29 (13%)
|
7 (19%)
|
22 (12%)
|
25 (20%)
|
4 (4%)
|
Other (neurologic, mixed)
|
23 (11%)
|
8 (22%)
|
15 (8%)
|
18 (15%)
|
5 (5%)
|
Not indicated
|
27 (12%)
|
5 (13%)
|
22 (12%)
|
22 (18%)
|
5 (5%)
|
Intubation technique
|
|||||
Direct laryngoscopy
|
209 (96%)
|
33 (89%)
|
176 (97%)
|
117 (96%)
|
92 (96%)
|
Other
|
9 (4%)
|
4 (11%)
|
5 (3%)
|
5 (4%)
|
4 (4%)
|
Number of intubation attempts
|
|||||
One
|
158 (72%)
|
16 (43%)
|
142 (78%)
|
80 (66%)
|
78 (81%)
|
Two
|
33 (15%)
|
12 (32%)
|
21 (12%)
|
21 (17%)
|
12 (13%)
|
≥ 3
|
27 (12%)
|
9 (24%)
|
18 (10%)
|
21 (17%)
|
6 (6%)
|
Complications
|
|||||
Esophageal intubation
|
42 (19%)
|
14 (37%)
|
28 (15%)
|
34 (28%)
|
8 (8%)
|
Regurgitation
|
35 (16%)
|
6 (16%)
|
29 (16%)
|
19 (16%)
|
16 (17%)
|
Aspiration
|
26 (12%)
|
5 (14%)
|
21 (12%)
|
15 (12%)
|
11 (11%)
|