Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient.

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Abstract

Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient.

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Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

S Barry Issenberg, William C McGaghie, Emil R Petrusa … (2005)

1969 to 2003, 34 years. Simulations are now in widespread use in medical education and medical personnel evaluation. Outcomes research on the use and effectiveness of simulation technology in medical education is scattered, inconsistent and varies widely in methodological rigor and substantive focus. Review and synthesize existing evidence in educational science that addresses the question, 'What are the features and uses of high-fidelity medical simulations that lead to most effective learning?'. The search covered five literature databases (ERIC, MEDLINE, PsycINFO, Web of Science and Timelit) and employed 91 single search terms and concepts and their Boolean combinations. Hand searching, Internet searches and attention to the 'grey literature' were also used. The aim was to perform the most thorough literature search possible of peer-reviewed publications and reports in the unpublished literature that have been judged for academic quality. Four screening criteria were used to reduce the initial pool of 670 journal articles to a focused set of 109 studies: (a) elimination of review articles in favor of empirical studies; (b) use of a simulator as an educational assessment or intervention with learner outcomes measured quantitatively; (c) comparative research, either experimental or quasi-experimental; and (d) research that involves simulation as an educational intervention. Data were extracted systematically from the 109 eligible journal articles by independent coders. Each coder used a standardized data extraction protocol. Qualitative data synthesis and tabular presentation of research methods and outcomes were used. Heterogeneity of research designs, educational interventions, outcome measures and timeframe precluded data synthesis using meta-analysis. Coding accuracy for features of the journal articles is high. The extant quality of the published research is generally weak. The weight of the best available evidence suggests that high-fidelity medical simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.

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Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

C. Frerk, V. Mitchell, A McNarry … (2015)

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

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Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.

Jeffrey L Apfelbaum, Carin Hagberg, Robert Caplan … (2013)

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Author and article information

Journal

Journal ID (iso-abbrev): Can J Anaesth

Title: Canadian journal of anaesthesia = Journal canadien d'anesthesie

Publisher: Springer Science and Business Media LLC

ISSN (Electronic): 1496-8975

ISSN (Print): 0832-610X

Publication date (Electronic): September 2021

Volume: 68

Issue: 9

Affiliations

[1 ] Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Room 5452, Halifax, NS, B3H 3A7, Canada. jlaw@dal.ca.

[2 ] Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.

[3 ] Département d'anesthésiologie et de soins intensifs, Université Laval, 2325 rue de l'Université, Québec, QC, G1V 0A6, Canada.

[4 ] Département d'anesthésie du CHU de Québec, Hôpital Enfant-Jésus, 1401 18e rue, Québec, QC, G1J 1Z4, Canada.

[5 ] Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.

[6 ] Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Suite CCW1401, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.

[7 ] Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.

[8 ] Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.

[9 ] Department of Anesthesia & Perioperative Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Rd., London, ON, N6A 5A5, Canada.

[10 ] Département d'anesthésiologie, CHU de Québec - Université Laval, Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, QC, G1R 2J6, Canada.

[11 ] Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada.

[12 ] Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON, Canada.

[13 ] Interdepartmental Division of Critical Care Medicine, University of Toronto, EN 442 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.

[14 ] Department of Anesthesia, BC Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.

[15 ] Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.

[16 ] Discipline of Anesthesia, St. Clare's Mercy Hospital, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, NL, A1B V6, Canada.

[17 ] Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St, Toronto, ON, M5T2S8, Canada.

Article

Publisher Item ID: 10.1007/s12630-021-02007-0

DOI: 10.1007/s12630-021-02007-0

PMC ID: 8212585

PubMed ID: 34143394

SO-VID: a5bee509-e2d3-4539-ad54-15cd0370608c

History

Keywords: tracheal,intubation,airway management,difficult,failed,guidelines

Data availability:

Keywords: tracheal, intubation, airway management, difficult, failed, guidelines

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient.

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Most cited references 304

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.

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