Prevalence and commonality of non-technical skills and human factors in airway management guidelines: a narrative review of the last 5 years.

The primary aim of this review was to identify, analyse and codify the prominence and nature of human factors and ergonomics within difficult airway management algorithms. A directed search across OVID Medline and PubMed databases was performed. All articles were screened for relevance to the research aims and according to predetermined exclusion criteria. We identified 26 published airway management algorithms. A coding framework was iteratively developed identifying human factors and ergonomic specific words and phrases based on the Systems Engineering Initiative for Patient Safety model. This framework was applied to the papers to delineate qualitative and quantitative results. Our results show that human factors are well represented within recent airway management guidelines. Human factors associated with work systems and processes featured more prominently than user and patient outcome measurement and adaption. Human factors are an evolving area in airway management and our results highlight that further considerations are necessary in further guideline development.

The Airway App: exploring the role of smartphone technology to capture emergency front-of-neck airway experiences internationally.

In this exploratory study we describe the utility of smartphone technology for anonymous retrospective observational data collection of emergency front-of-neck airway management. The medical community continues to debate the optimal technique for emergency front-of-neck airway management. Although individual clinicians infrequently perform this procedure, hundreds are performed annually worldwide. Ubiquitous smartphone technology and internet connectivity have created the opportunity to collect these data. We created the 'Airway App', a smartphone application to capture the experiences of healthcare providers involved in emergency front-of-neck airway procedures. In the first 18-month period, 104 emergency front-of-neck airway management reports were received; 99 (95%) were internally valid and unique from 21 countries. Eighty-one (82%) were performed by non-surgeons and 63 (64%) were 'cannot intubate, cannot oxygenate' emergencies. Overall first-attempt success varied by technique; 45 scalpel-bougie cricothyroidotomy (37 first-attempt success), 25 surgical cricothyroidotomy (15 first-attempt success), eight cannula cricothyroidotomy (five first-attempt success), six wire-guided cricothyroidotomy (three first-attempt success) and 15 tracheostomy reports (11 first-attempt success). The most commonly reported positive human factors were good communication, good teamwork and/or skilled personnel. The most commonly reported negative human factors were fixation on multiple tracheal intubation attempts, delay in initiating emergency front-of-neck airway and/or the failure to plan for failure. Due to the anonymous nature of reporting, reports are open to recollection bias and spurious reporting. We conclude collection of data using a smartphone application is feasible and has the potential to expand our knowledge of emergency front-of-neck airway management.

Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: a systematic review.

BACKGROUND: Transtracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness. METHODS: Our goal was to determine the complication rates of TTJV in the CICO emergency compared with the emergency setting where CICO is not described (non-CICO emergency) or elective surgical setting. Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects. Complications were categorized as device failure, barotrauma (including subcutaneous emphysema), and miscellaneous. Device failure was defined by the inability to place and/or use the TTJV device, not patient survival. RESULTS: Forty-four studies (428 procedures) met the inclusion criteria. Four studies included both emergency and elective procedures. Thirty studies described 132 emergency TTJV procedures; 90 were CICO emergencies. Eighteen studies described 296 elective TTJV procedures. Device failure occurred in 42% of CICO emergency vs 0% of non-CICO emergency (P<0.001) and 0.3% of elective procedures (P<0.001). Barotrauma occurred in 32% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). The total number of procedures with any complication was 51% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). Several reports described TTJV-related subcutaneous emphysema hampering subsequent attempts at surgical airway or tracheal intubation. CONCLUSIONS: TTJV is associated with a high risk of device failure and barotrauma in the CICO emergency. Guidelines and recommendations supporting the use of TTJV in CICO should be reconsidered.