Evaluation of rescue techniques following failed laryngoscopy: A multicenter prospective observational study

The Fourth National Audit Project revealed that severe airway complications occur in the frequency of 1/22,000. Various rescue techniques were recommended in difficult airway guidelines. This study aims to evaluate the rescue techniques following failed direct laryngoscopy and analyze the success rates and potential complications during difficult airway management.

This was a multicenter and prospective observational study carried out in four referral centers. Four academic university hospitals using fiberoptic bronchoscopy and videolaryngoscopy in their daily practice were included in the study. Patients undergoing general anesthesia with anticipated or unanticipated difficult intubation were enrolled. The preferred rescue technique and the attempts for both direct and indirect laryngoscopies were recorded.

At the mean age of 46.58±21.19 years, 92 patients were analyzed. The most common rescue technique was videolaryngoscopy following failed direct laryngoscopy. Glidescope was the most preferred videolaryngoscope. Anesthesia residents performed most of the first tracheal intubation attempts, whereas anesthesia specialists performed the second attempts at all centers. The experience of the first performer as a resident was significantly higher in the anticipated difficult airway group (4.0±5.5 years) (p=0.045). The number of attempts with the first rescue technique was 2.0±2.0 and 1.0±1.0 in the unanticipated difficult airway and anticipated difficult airway groups, respectively (p=0.004).

Videolaryngoscopy was a more commonly preferred technique for both anticipated and unanticipated difficult intubations. Glidescope was the most used rescue device in difficult intubations after failed direct laryngoscopy, with a high success rate.