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Emergency surgical airway in life-threatening acute airway emergencies – why are we so reluctant to do it?

Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland; Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, South Australia; Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria; Department of Anaesthesia and Pain Medicine, Royal Perth Hospital and University of Western Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Auckland City Hospital and University of Auckland, Auckland, New Zealand and Department of Anaesthesiology, University of Hong Kong, Hong Kong SAR

Summary

'Can’t intubate, can't oxygenate' scenarios are rare but are often poorly managed, with potentially disastrous consequences. In our opinion, all doctors should be able to create a surgical airway if necessary. More practically, at least all anaesthetists should have this ability. There should be a change in culture to one that encourages and facilitates the performance of a life-saving emergency surgical airway when required. In this regard, an understanding of the human factors that influence the decision to perform an emergency surgical airway is as important as technical skill. Standardisation of difficult airway equipment in areas where anaesthesia is performed is a step toward ensuring that an emergency surgical airway will be performed appropriately. Information on the incidence and clinical management of 'can’t intubate, can’t oxygenate' scenarios should be compiled through various sources, including national coronial inquest databases and anaesthetic critical incident reporting systems. A systematic approach to teaching and maintaining human factors in airway crisis management and emergency surgical airway skills to anaesthetic trainees and specialists should be developed: in our opinion participation should be mandatory. Importantly, the view that performing an emergency surgical airway is an admission of anaesthetist failure should be strongly countered.

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