The Difficult Airway Trolley: A Narrative Review and Practical Guide

Area of Science:

• Anesthesiology
• Emergency Medicine
• Critical Care

Background:

• Failed difficult airway management is a leading cause of anesthesia-related death and severe morbidity.
• Current guidelines offer limited direction on difficult airway trolley setup.
• Rapid access to specialized equipment is crucial during airway emergencies.

Purpose of the Study:

• To design a dedicated difficult airway trolley for patients over 12 years old.
• To organize equipment based on a four-step difficult airway algorithm for sequential use.
• To provide a standardized, accessible resource for airway management in various clinical settings.

Main Methods:

• Systematic literature search of PubMed, Embase, and Google Scholar.
• Analysis of 11 national/international guidelines and peer-reviewed journals.
• Development of a trolley design with contents organized into four drawers corresponding to algorithm steps (A-D).

Main Results:

• A difficult airway trolley design is presented, organized by a four-step algorithm: intubation (A), supraglottic airway (B), facemask ventilation (C), and invasive airway access (D).
• The trolley design facilitates logical progression through rescue strategies during airway emergencies.
• A fifth drawer allows for inclusion of specialized equipment, enhancing versatility.

Conclusions:

• A well-designed, guideline-based difficult airway trolley is essential for clinicians managing airways.
• This trolley design supports adherence to difficult airway algorithms in critical situations.
• Further research on device availability and trolley comparison through simulation is recommended.