UHCW publication: Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario.
C. F. Pairaudeau, C. Mendonca, C. Hillermann, I. Qazi, P. A. Baker, R. E. Hodgson, S. Radhakrishna

Anaesthesia 2018 Jan 19. doi: 10.1111/anae.14218
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.


Full text PDF available at  http://onlinelibrary.wiley.com/doi/10.1111/anae.14218/epdf (UHCW Athens login required)

Temporary suspension of undetected oesophageal intubation category of Never Event

The new ‘undetected oesophageal intubation’ category of Never Event has been temporarily suspended from the 2018 Never Events list while a query about it is being resolved.

You will not need to report this category of incident as a Never Event until the suspension has been lifted. We will let you know when this category of Never Event has been reinstated.

Reducing the risk of oxygen tubing being connected to air flowmeters

A stage three patient safety alert has been issued by NHS Improvement to support NHS providers that supply medical air using medical gas pipeline systems (MGPSs) to reduce the risk of harm from oxygen tubing being connected to air flowmeters.

Watch the 2-minute video to support this Patient Safety Alert.

Use of physostigmine in patients presenting to the emergency department with anticholinergic poisoning

New from BestBETs:

In [patients presenting to the emergency department with anticholinergic toxidrome], does the administration of [physostigmine] compared to [any other treatment] reduces [length of stay or need for intubation]?

In patients presenting to the ED with anticholinergic poisoning, the use of physostigmine might reduce the intubation rate, but not the mean length of stay. Unfortunately, the current data is very weak and prone to bias. Further prospective randomized studies on the subject are needed to support its use in anticholinergic toxicity.

Should real resuscitationists use airway checklists?

New from BestBETs:

In [critically ill patients requiring endotracheal intubation] does [the use of a preprocedural checklist] reduce [the incidence of adverse events].

Current evidence suggests there may be a potential reduction in adverse events with the use of preprocedural checklists, during intubation of the critically ill patient outside a theatre environment. However, this evidence is level 3 at best and should be considered hypothesis generating. Further evidence is required before airway checklists can be considered a standard of care.

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A & A case reports 2016

In patients with cervical spine injuries, emergence from anesthesia and tracheal extubation can prove as challenging to the anesthesiologist as the tracheal intubation. We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care. The case report is followed by a review of literature relating to safe extubation of patients with cervical spine injuries. Possible complications during emergence and various methods to prevent these complications are discussed.

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ESICM LIVES 2016: part one Milan, Italy. 1-5 October 2016

The aim of this project was to establish if there are significant differences between the Triggers which predicted VAPs (VAP triggers) as opposed to triggers which did not predict a VAP (Non VAP triggers) where both groups had triggered an alert.

UHCW Research: C Groves

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Anaesthesia (ANAESTHESIA), Aug2016; 71(8): 908-914. (7p)

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Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.

UHCW Research - Mendonca C