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AIRWAY MANAGEMENT OUTSIDE OF THE OPERATING ROOM: A SURVEY OF CRITICAL CARE MEDICINE PROGRAM DIRECTORS

University of Pittsburgh, Pittsburgh, PA

PURPOSE: Airway management is a crucial skill important in prevention of hypoxic cerebral injury. The management of the airway outside of the operating room (OR) is often carried out by diverse personnel and under difficult conditions. The best method for teaching and maintaining these skills is not clear. Our purpose was to survey adult Critical Care Medicine training programs in the United States regarding airway management outside of the OR.

METHODS: All program directors of adult Critical Care Fellowships were identified from the Graduate Medical Education directory for the year 2005-2006. An electronic survey was sent to each director by e-mail. The survey included questions regarding the personnel responsible for airway management, their clinical specialty, and airway management practices. In addition, the survey included questions on training methods used during the fellowship. Respondents were permitted to select more than one response where appropriate.

RESULTS: Ninety three (37%) of the 251 program directors responded. Critical care physicians (80% of respondents) and anesthesiologists (72% of respondents) managed the airways most of the time in the ICU. However, house staff (37% in the ICU and 46% in ward) and respiratory therapists (25% in ICU and 29% in ward) also provided airway management. The most frequently used sedative and paralytic agents were Etomidate (35%) and succinyl choline (67%). Forty seven percent of programs reported between one and five cricothyrotomies per year outside of the OR. Sixty four percent of programs used simulation and 59% required at least ten intubations for proficiency. The duration of training and techniques of airway management varied by program.

CONCLUSION: In our survey there was wide variation in personnel managing the airway, airway management practices, and teaching methods of airway skills outside of the OR.

CLINICAL IMPLICATIONS: Development of a curriculum for training in airway management for the non-anesthesiologist could facilitate standardization of airway management outside of the operating room.

DISCLOSURE: Adam Akers, None.