Devices for difficult airway management in academic emergency departments: results of a national survey

Abstract

Study objective: We conducted a national survey of emergency medicine residency program directors to determine which alternative devices were available in their emergency departments for difficult airway management. We also assessed the residency directors' experience in use of these devices.

Methods: After approval was received from the institutional review board at our institution, residency directors were contacted by mail, fax, or phone in October 1997. Alternative intubation devices were defined as devices that do not involve use of a laryngoscope and direct visualization for tracheal tube placement. Alternative ventilation devices were defined as those that do not use a face mask for ventilation. We asked whether the following alternative intubation devices were stocked in their department: a flexible fiberoptic bronchoscope, a rigid fiberoptic device (ie, Bullard, Wu-Scope), a lighted stylet, or a retrograde intubation kit. We also asked about the following alternative ventilation devices: a transtracheal jet ventilation system with a 50-psi oxygen source and control valve, the esophageal tracheal twin-lumen airway device (Combitube), or the laryngeal mask airway. Residency directors were also questioned about their duration of practice, intubation experience, and use of these devices.

Results: We obtained information from 95 of 118 (81%) programs. Of 95 programs, 61 (64%) had a fiberoptic bronchoscope, 43 (45%) a retrograde intubation kit, 33 (35%) a lighted stylet, and 6 (.06%) a rigid fiberoptic device. Forty-seven (49%) of the programs reported 2 or more devices, and 20 (21%) reported having no alternative intubation devices. Of 95 programs, 64 (67%) had a transtracheal jet ventilation system, 25 (26%) had the Combitube, and 25 (26%) had the laryngeal mask airway. Thirty-one (33%) programs had at least 2 alternative ventilation devices, and 20 (21%) had none. Ten (11%) programs had no alternative intubating or ventilation devices. Additional information on duration of practice, intubation experience, and actual use of alternative devices was obtained from 83 of the 95 (87%) emergency medicine residency directors contacted. Forty-one (49%) reported never having used an alternative device for intubation. The most commonly used alternative intubation device was the flexible fiberoptic bronchoscope (37%), and the mean number of times any alternative device was used was 7.

Conclusion: The availability of devices for difficult airway management varies tremendously across emergency medicine residency programs. Only half of residency program directors had any experience with these devices, and among those that reported any experience, they are used rarely.