Initiation of Airway Code: the Role of the Airway Team in Unexpected Difficult Airways

NCT ID: NCT06448377

Last Updated: 2024-10-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

48 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-03-15

Study Completion Date

2024-10-15

Brief Summary

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The aim of our study is to observationally examine our unexpected difficult airway incidence and intervention times. In addition, it is aimed to discuss the clinical effect of a team specialized in airway intervention intervening in cases by call on the success of airway intervention. In this discussion, it is aimed to use the opinion-opposition method.

Detailed Description

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Initiation of Airway Code: The Role of the Airway Team in Unexpected Difficult Airways

The incidence of difficult airway is approximately 1 in 1000 cases and poses a significant perioperative risk to patients. Various classifications, guidelines, and approaches have been developed to identify patients with difficult airways. However, even the most well-known classifications are not 100% successful in predicting difficult airways. Consequently, some unexpected difficult airway cases are encountered, and their management continues to be a subject of new research in the literature.

In situations involving difficult airways, having the same team respond to every case may pose a potential obstacle to the distribution of experience and responsibilities among other clinical staff. However, it is undeniable that experienced anesthetists are more successful in airway management, and the importance of airway-related training cannot be overstated. Similar to the code blue protocol used during cardiac arrests, the intervention of a trained external team in crisis situations, utilizing familiar equipment and applying data from previous cases for quality improvement, can provide significant benefits in airway management akin to those seen in cardiac arrests. This approach could also potentially enhance patient safety in internal medicine and surgical wards, as well as in certain intensive care units, where familiarity with airway management is limited.

This study aims to discuss the positive and negative impacts of the airway teams intervention in unexpected difficult airway situations within the operating room, using a pro-con debate method.

Conditions

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Unexpected Difficult Airway Intubation;Difficult Airway Management

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Airway Team Group

In this group, the intervention time and methods used by the airway team will be evaluated in patients who have been called for airway assistance.

Videolaryngoscopy

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a videolaryngoscope during airway intervention will be included in this group.

FOB

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a fiberoptic bronchoscope during airway intervention will be included in this group.

FOB+Aintree

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a Fiberoptic intubation via LMA with aintree catheter during airway intervention will be included in this group.

Classic intubation with laryngoscopy

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a macintosh laryngoscope during airway intervention will be included in this group.

Others

Intervention Type PROCEDURE

Cases in which intubation cannot be performed, those who are awakened from anesthesia, or those in whom a surgical method is used for airway access will be included in this group.

Control Group

In this group, anesthesiologists' feedback on difficult airway cases will be received.

Videolaryngoscopy

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a videolaryngoscope during airway intervention will be included in this group.

FOB

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a fiberoptic bronchoscope during airway intervention will be included in this group.

FOB+Aintree

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a Fiberoptic intubation via LMA with aintree catheter during airway intervention will be included in this group.

Classic intubation with laryngoscopy

Intervention Type PROCEDURE

Situations in which the practitioner performs endotracheal intubation using a macintosh laryngoscope during airway intervention will be included in this group.

Others

Intervention Type PROCEDURE

Cases in which intubation cannot be performed, those who are awakened from anesthesia, or those in whom a surgical method is used for airway access will be included in this group.

Interventions

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Videolaryngoscopy

Situations in which the practitioner performs endotracheal intubation using a videolaryngoscope during airway intervention will be included in this group.

Intervention Type PROCEDURE

FOB

Situations in which the practitioner performs endotracheal intubation using a fiberoptic bronchoscope during airway intervention will be included in this group.

Intervention Type PROCEDURE

FOB+Aintree

Situations in which the practitioner performs endotracheal intubation using a Fiberoptic intubation via LMA with aintree catheter during airway intervention will be included in this group.

Intervention Type PROCEDURE

Classic intubation with laryngoscopy

Situations in which the practitioner performs endotracheal intubation using a macintosh laryngoscope during airway intervention will be included in this group.

Intervention Type PROCEDURE

Others

Cases in which intubation cannot be performed, those who are awakened from anesthesia, or those in whom a surgical method is used for airway access will be included in this group.

Intervention Type PROCEDURE

Other Intervention Names

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endotracheal intubation with fiberoptic bronchoscope Fiberoptic intubation via LMA with aintree catheter

Eligibility Criteria

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Inclusion Criteria

1. Patients who will be operated under general anesthesia at Kocaeli City Hospital or who require perioperative endotracheal intubation will be included in our study.
2. Operations performed within the study time period will be taken
3. Patients whose anesthesiologists call for help for difficult airway will be included in the study.
4. Patients between the ages of 18-65 will be included in the study.

Exclusion Criteria

\- 1. Expected difficult airway patients (mallampati 3-4) and other patients with high difficult airway scores will not be included in the study.

2\. Patients with difficult airway conditions but who will be awakened by giving up endotracheal intubation will not be included in the study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kocaeli City Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ahmet YUKSEK, Md

Role: PRINCIPAL_INVESTIGATOR

Kocaeli Cith Hospital

Locations

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Kocaeli City Hospital

Kocaeli, Izmıt, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Pandian V, Ghazi TU, He MQ, Isak E, Saleem A, Semler LR, Capellari EC, Brenner MJ. Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review. Ann Otol Rhinol Laryngol. 2023 Aug;132(8):938-954. doi: 10.1177/00034894221123124. Epub 2022 Oct 2.

Reference Type BACKGROUND
PMID: 36189709 (View on PubMed)

Karamchandani K, Wheelwright J, Yang AL, Westphal ND, Khanna AK, Myatra SN. Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies. Anesth Analg. 2021 Sep 1;133(3):648-662. doi: 10.1213/ANE.0000000000005644.

Reference Type BACKGROUND
PMID: 34153007 (View on PubMed)

Penketh J, Nolan JP. Airway management during cardiac arrest. Curr Opin Crit Care. 2023 Jun 1;29(3):175-180. doi: 10.1097/MCC.0000000000001033. Epub 2023 Mar 28.

Reference Type BACKGROUND
PMID: 37078613 (View on PubMed)

Mark LJ, Herzer KR, Cover R, Pandian V, Bhatti NI, Berkow LC, Haut ER, Hillel AT, Miller CR, Feller-Kopman DJ, Schiavi AJ, Xie YJ, Lim C, Holzmueller C, Ahmad M, Thomas P, Flint PW, Mirski MA. Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies. Anesth Analg. 2015 Jul;121(1):127-139. doi: 10.1213/ANE.0000000000000691.

Reference Type BACKGROUND
PMID: 26086513 (View on PubMed)

Koh W, Kim H, Kim K, Ro YJ, Yang HS. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol. 2016 Jun;69(3):244-9. doi: 10.4097/kjae.2016.69.3.244. Epub 2016 Jun 1.

Reference Type BACKGROUND
PMID: 27274369 (View on PubMed)

Other Identifiers

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2025-25

Identifier Type: -

Identifier Source: org_study_id

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