Emergency airway service by anaesthetists: a selective referral approach

Introduction

We describe our experience with the provision of an emergency airway service by specialist-grade anaesthestists to assist the primary physicians who are the first-line personnel in airway management and resuscitation in our 1249-bedded multi-disciplinary, tertiary hospital. A dedicated paging system was set up to facilitate rapid activation of the designated anaesthetist.

Method

A prospective audit was conducted over 6 months to assess the demand and effectiveness of the service. A questionnaire was completed for each activation by the anaesthesiologist involved.

Results

There were 68 activations (average of 11.3/month), 64.7% of which occurred after 16:30 hours. The main locations were the Neurological Intensive Care Unit (24%), Medical Intensive Care Unit (11.8%) and Coronary Care Unit (11.8%). In 54.4% of the activations, endotracheal intubation was already attempted by the primary physicians, with 19.1% of the patients requiring more than two attempts. In 19.1% of cases, the involvement extended to participating in other aspects of resuscitation. Majority of the scenarios were clinically challenging, benefiting from a specialist anaesthetist input. Forty-three percent of the patients had anterior larynces. One patient required an emergency tracheostomy.

Discussion

Cardiac arrest teams are costly and there remains a lack of concrete evidence to show that they improve patient outcome. Recently, medical emergency teams are introduced to provide rapid response to critically ill patients. However, these teams face many practical problems, such as limited understanding of the implication of cardiac arrest and hence, the appropriateness of resuscitation. While retaining a 'primary physician team resuscitation' approach, the emergency airway service provided a scope of care equivalent to both cardiac and medical emergency teams as required, at a lower cost.

Conclusion

We conclude that this system of emergency airway management support by anaesthesiologists is effective and optimises manpower resources.