A survey of emergency airway management in the United Kingdom

Abstract

A postal questionnaire aiming to ascertain the availability of cricothyrotomy and transtracheal ventilation equipment, and experience of its use, was sent to all tutors of the Royal College of Anaesthetists in the United Kingdom and Ireland. The response rate was 74.9%. Almost half of the respondents had experience of cricothyrotomy. The 'Portex Minitrach' (58.6%) was the most commonly used preformed device, followed by the 'William-Cook' cannula (8.5%). The 14-G intravenous cannula (21.1%) was the most frequently improvised cricothyrotomy device. Seventy six percent of all theatres had equipment available for such emergency airway management. Sixty five percent of Portex-Minitrach insertions resulted in complications, more than half of which were serious (total failure to cannulate (17.1%), multiple attempts (20.7%), pneumothorax (8.5%) and severe bleeding (7.3%)). Major complication rates of the 'William-Cook' device and 14-G intravenous cannula were 27.3% and 22.2% respectively. Seventy five percent of patients reported had eventual successful airway management with full recovery, while 9.6% had partial recovery and 15.4% died. Formal training of emergency airway management was practised in 14.2% of anaesthetic departments, while 73.6% had informal training. Twelve percent of the departments did not specifically teach their trainees the skill of emergency airway management.