Development of the obstetric unanticipated difficult video-laryngoscopy algorithm through a quality improvement...

Area of Science:

• Anesthesiology
• Airway Management
• Obstetric Anesthesia

Background:

• Video-laryngoscopy is increasingly utilized for general anesthesia in emergency cesarean deliveries.
• Difficult tracheal intubation poses a heightened risk in obstetric patients, necessitating effective airway management strategies.
• This study addresses airway management challenges in simulated emergency cesarean deliveries.

Purpose of the Study:

• To compare the efficacy of flexible bronchoscopy versus the Eschmann introducer as rescue devices during video-laryngoscopy in simulated emergency cesarean deliveries.
• To evaluate the time to secure the airway and other critical outcomes between the two rescue devices.

Main Methods:

• A simulation study involving 28 anesthesia trainees randomized into two groups (n=14/group).
• Trainees used either a flexible bronchoscope or an Eschmann introducer as a rescue device with video-laryngoscopy in a simulated emergency cesarean delivery scenario.
• Primary outcome: time to intubation. Secondary outcomes: hypoxemia, need for bag-mask ventilation, and failed intubation.

Main Results:

• Flexible bronchoscopy resulted in significantly shorter intubation times (24±10s) compared to the Eschmann introducer (86±35s) (P<0.0001).
• The flexible bronchoscopy group had no hypoxemia or need for bag-mask ventilation, unlike the Eschmann introducer group (71% incidence for both; P=0.0002).
• All flexible bronchoscopy-aided intubations were successful on the first attempt; failed intubation rates were similar between groups.

Conclusions:

• Flexible bronchoscopy, when used with video-laryngoscopy, offers a faster method for tracheal intubation compared to the Eschmann introducer in simulated emergency obstetric scenarios.
• This suggests flexible bronchoscopy may be a more effective rescue device for managing difficult airways in emergency cesarean deliveries.