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Randomized Controlled Trial
. 2016 May;116(5):680-9.
doi: 10.1093/bja/aew057.

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

A K Nørskov  1 , J Wetterslev  2 , C V Rosenstock  3 , A Afshari  4 , G Astrup  5 , J C Jakobsen  6 , J L Thomsen  7 , M Bøttger  8 , M Ellekvist  4 , B M B Schousboe  9 , A Horn  10 , B G Jørgensen  11 , K Lorentzen  12 , M H Madsen  3 , J S Knudsen  13 , B K Thisted  14 , S Estrup  15 , H B Mieritz  16 , T Klesse  17 , H J Martinussen  18 , A G Vedel  19 , R Maaløe  20 , K B Bøsling  21 , P R C Kirkegaard  22 , C R Ibáñez  23 , G Aleksandraviciute  24 , L S Hansen  25 , T Mantoni  26 , L H Lundstrøm  3
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Free article
Randomized Controlled Trial

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

A K Nørskov et al. Br J Anaesth. 2016 May.
Free article

Abstract

Background: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.

Methods: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.

Results: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).

Conclusions: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.

Clinical trial registration: NCT01718561.

Keywords: airway management; cluster analysis; preoperative care; randomized controlled trial.

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