Airway fires in otolaryngologic surgery: A database review

Area of Science:

• Otolaryngology
• Surgical Safety
• Medical Device Safety

Background:

• Operating room fires pose a significant risk, with an estimated 34% involving the airway.
• Education on preventing and managing airway fires during otolaryngologic surgery is insufficient in graduate medical training.
• A lack of literature reporting rare airway fire events contributes to limited awareness.

Purpose of the Study:

• To analyze the incidence, characteristics, and outcomes of airway fires during surgical procedures.
• To identify common triggering factors and management strategies for airway fires.
• To inform educational strategies and improve patient safety in otolaryngologic surgery.

Main Methods:

• The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried.
• Adverse event reports related to airway fires from January 1, 2010, to March 31, 2020, were included.
• 3687 reports were identified, with 49 unique cases of airway fire analyzed.

Main Results:

• 49 unique airway fire reports were analyzed, with 16 (32.7%) sustained fires and 33 (67.3%) transient flares.
• Tonsillectomy (44.9%), vocal fold excision (10.2%), and adenoidectomy (8.2%) were the most common procedures involved.
• 16 patient and 2 operator injuries were reported; immediate extubation occurred in only 12.5% of sustained fires.

Conclusions:

• Airway fires occur in various otolaryngologic procedures, often triggered by sparks or char.
• Management strategies, such as immediate endotracheal tube removal, were infrequently reported.
• Findings underscore the need for enhanced training in airway fire prevention and management for otolaryngologists.