Difficult Airway Response Team Outcomes in an Academic Emergency Department: A Prospective, Multidisciplinary Airway...

Successful first-attempt intubation minimizes the risk of hypoxemia, hypoventilation, and hypoperfusion. However, few data exist on outcomes of team-based difficult airway management in the Emergency Department (ED) for patients with deteriorating respiratory status.

To investigate the outcomes of an ED Difficult Airway Response Team (DART) program.

A prospective observational cohort study of DART implementation was conducted in the ED of an academic, tertiary care institution over a five-year period. An activation protocol was established, and the DART team included emergency physicians, other physicians (anesthesiologists, otolaryngologists, and trauma surgeons), respiratory therapists, nurses, and staff. Patients 18 years or older managed by the DART in the ED were included. Outcome measures included first-attempt intubation success, intubation techniques, and need for surgical airway.

Across 98 DART activations, 73 patients were managed in ED, nine patients were transported directly to the operating room, and 16 were transported to the operating room after an unsuccessful attempt at airway securement. Advanced airway techniques (fiberoptic bronchoscopy or videolaryngoscopy) accounted for 76% of first-attempt success with airway securement versus 24% for direct laryngoscopy (p<.01). Difficulty with bag-mask ventilation, need for cardiopulmonary resuscitation, and underlying illness predicted lower first attempt success rates (all p <.01). Surgical interventions were required in 17 patients, and 6 patients underwent cricothyroidotomy. There were no airway-related mortalities. Airway anatomy, difficult airway history, and context were associated with equipment selection, transport to operating room, and need for surgical airway.

In this DART implementation, the first attempt intubation success was associated with use of advanced airway techniques and favorable patient characteristics.