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. 2018 Mar;128(3):502-510.
doi: 10.1097/ALN.0000000000001974.

Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice

Rebecca A Schroeder  1 , Richard Pollard, Ishwori Dhakal, Mary Cooter, Solomon Aronson, Katherine Grichnik, William Buhrman, Miklos D Kertai, Joseph P Mathew, Mark Stafford-Smith
Affiliations

Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice

Rebecca A Schroeder et al. Anesthesiology. 2018 Mar.

Abstract

Background: When tracheal intubation is difficult or unachievable before surgery or during an emergent resuscitation, this is a critical safety event. Consensus algorithms and airway devices have been introduced in hopes of reducing such occurrences. However, evidence of improved safety in clinical practice related to their introduction is lacking. Therefore, we selected a large perioperative database spanning 2002 to 2015 to look for changes in annual rates of difficult and failed tracheal intubation.

Methods: Difficult (more than three attempts) and failed (unsuccessful, requiring awakening or surgical tracheostomy) intubation rates in patients 18 yr and older were compared between the early and late periods (pre- vs. post-January 2009) and by annual rate join-point analysis. Primary findings from a large, urban hospital were compared with combined observations from 15 smaller facilities.

Results: Analysis of 421,581 procedures identified fourfold reductions in both event rates between the early and late periods (difficult: 6.6 of 1,000 vs. 1.6 of 1,000, P < 0.0001; failed: 0.2 of 1,000 vs. 0.06 of 1,000, P < 0.0001), with join-point analysis identifying two significant change points (2006, P = 0.02; 2010, P = 0.03) including a pre-2006 stable period, a steep drop between 2006 and 2010, and gradual decline after 2010. Data from 15 affiliated practices (442,428 procedures) demonstrated similar reductions.

Conclusions: In this retrospective assessment spanning 14 yr (2002 to 2015), difficult and failed intubation rates by skilled providers declined significantly at both an urban hospital and a network of smaller affiliated practices. Further investigations are required to validate these findings in other data sets and more clearly identify factors associated with their occurrence as clues to future airway management advancements.

Visual abstract: An online visual overview is available for this article at http://links.lww.com/ALN/B635.

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Comment in

  • Advancing Patient Safety in Airway Management.
    Aziz MF. Aziz MF. Anesthesiology. 2018 Mar;128(3):434-436. doi: 10.1097/ALN.0000000000002075. Anesthesiology. 2018. PMID: 29324483 No abstract available.
  • Airway Management: The Less Popular Skill of Bag-mask Ventilation.
    Rosen GP, Viswanath O, Wigley JC, Kerner B. Rosen GP, et al. Anesthesiology. 2018 Nov;129(5):1049-1050. doi: 10.1097/ALN.0000000000002420. Anesthesiology. 2018. PMID: 30325812 No abstract available.
  • In Reply.
    Schroeder RA, Pollard R, Stafford-Smith M. Schroeder RA, et al. Anesthesiology. 2018 Nov;129(5):1050-1051. doi: 10.1097/ALN.0000000000002421. Anesthesiology. 2018. PMID: 30325813 No abstract available.

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