Navigation Links
Need for emergency airway surgery for hard-to-intubate patients reduced

Be prepared, that old Boy Scout motto, is being applied with great success to operating room patients whose anatomy may make it difficult for physicians to help them breathe during surgery, Johns Hopkins researchers report in a new study.

When patients undergo general anesthesia, they stop breathing on their own and anesthesiologists must quickly insert a tube into the airway as a first step in machine-assisted breathing. The researchers showed that a comprehensive program designed to help physicians quickly identify and treat anesthetized patients in which placement of this tube is difficult has dramatically reduced the need for high-risk emergency surgical procedures to open obstructed airways.

At the heart of the program is a rolling cart armed with most any supply a physician would need to navigate a difficult airway and restart breathing, from flexible scopes and long catheters to medications and a surgical airway kit, just in case. While it may sound simple, the standardized cart cuts out the need for operating room staff to race here and there during a crisis to track down the gear needed to get oxygen flowing again, says Lauren C. Berkow, M.D., one of the study's leaders.

"It seems an obvious solution, but it's not what people are used to doing," says Berkow, an assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "People had to run to five different places to get the right equipment.

"The stakes are pretty high. Oxygen is vital. Time is of the essence. You want to make sure you have everything you need and know how to use it when that patient with an emergency rolls through the door."

During the four years before Johns Hopkins put its difficult airway program into place, an average of 6.5 patients a year needed to have their airways opened surgically. Over the 11 years that followed ending in December 2006 an average of just 2.2 patients a year needed the emergency procedure. In the past year, Berkow says, no patients at Johns Hopkins have needed unplanned emergency airway surgery.

The findings are published online and will be in the December issue of the journal Anesthesia & Analgesia.

The cart is but one part of Hopkins' difficult airway program. Doctors have been educated how to spot someone with a potentially life-threatening obstruction and how to use the items on the cart to properly deal with it. When it is difficult to put a breathing tube in place for a particular patient, that information goes into the patient's electronic health record so future providers will be aware of and prepared to deal with potential problems.

The decrease in the number of surgical airway procedures at Hopkins occurred despite an increase in patients reported to have a "difficult airway" as well as an overall increase in the number of patients receiving anesthesia per year, Berkow says. Airway-related deaths also declined after the initiation of the program, but the difference was not statistically significant because of the small numbers.

More patients are appearing with difficult airways, she says, as the population gets older, sicker and larger all signals that inserting a breathing tube could be tricky. Presently, only one to 10 percent of patients have difficult airways, Berkow says. A miniscule number of those will require surgical intervention an incision just below the Adam's apple or into the trachea to ensure air is getting into the lungs.

"We took disorganization and created an organized, standardized system, which we've continued to adapt and update as new technology comes out. We keep all of our staff updated on the system," Berkow says, "and we found it improves outcomes."


Contact: Stephanie Desmon
Johns Hopkins Medical Institutions

Related medicine news :

1. Retired NYPD Lieutenants William E. Keegan, Jr., Owen McCaffery and John Moran and Tom Thees, a former COO in the financial industry, announce today the formation of H.E.A.R.T (Healing Emergency Aid Response Team) 911.
2. Temple Emergency Medicine receives $1.8M to find best MRSA treatment
3. Academy releases emergency preparedness tools to enable millions more people to shelter in place
4. Texas Aviation Services: Over 20 Years of Creating Flying Emergency Rooms for Airborne EMS Customers in US and Latin America
5. American Heart Association Enhances eLearning for Emergency Cardiovascular Care (ECC)
6. Giving emergency nurses aromatherapy massages with music dramatically reduced stress levels
7. Mecklenburg EMS Introduces Most-Advanced Situational Training in America for Emergency Medical Personnel
8. Giving emergency nurses aromatherapy massages with music dramatically reduced stress levels
9. Verathon Inc. Introduces GlideScope(R) Ranger Single Use Video Laryngoscope for Emergency Departments, EMS and Military; Enables Fast Intubations and Eliminates Time-Consuming Disinfection
10. Connecticut Bishops Back Down over Provision of Emergency Contraception
11. Vital Work of Emergency Nurses Honored Across the Nation During Emergency Nurses Week, October 7-13, 2007
Post Your Comments:
(Date:12/1/2015)... ... , ... Nurotron Biotechnology Co., Ltd., maker of cochlear implant systems, has won ... order will be from the China Disabled Persons’ Federation, a central government association, for ... for children and adults suffering from severe and profound hearing loss . The ...
(Date:12/1/2015)... Charlotte, NC (PRWEB) , ... December 01, 2015 ... ... NHS Foundation Trust on receiving the 2015 HSJ Acute Sector Innovation Award on ... of improving the patient care experience, and propose exciting enhancements to the medical ...
(Date:11/30/2015)... ... November 30, 2015 , ... Third Molar ... that it has officially launched a sleek, mobile-ready and user-centric redesigned website. , ... new website clearly outlines the benefits that its SEO services provide to dentists ...
(Date:11/30/2015)... NC (PRWEB) , ... November 30, 2015 , ... Trevor ... corporate support as they play for the chance to represent the United States. This ... the opportunity to be a part of their journey in addition to offering corporate ...
(Date:11/30/2015)... Garden City, NY (PRWEB) , ... December 01, ... ... (NAPW) honors Christina Colon as a 2015-2016 inductee into its ... for leadership in pharmacy. NAPW is the nation’s leading networking organization exclusively for ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... TOKYO , 1 décembre 2015 ... plus grande exposition et conférence d,Asie ... médicaux et sur l,industrie manufacturière, se ... du 20 au 22 avril ... - Photo - ...
(Date:11/30/2015)... December 1, 2015 ... adds "Endometriosis - Pipeline Review, H2 2015" ... on therapeutic pipeline of Endometriosis and helps ... counter strategies to gain competitive advantage. It ... and MOAs to produce first-in-class and best-in-class ...
(Date:11/30/2015)... , Nov. 30, 2015  DURECT Corporation ... Matt Hogan , Chief Financial Officer, ... Conference on Tuesday, December 8 at 2:45 ... held at the Westin Grand Central Hotel ... available for one-on-one meetings at this conference; ...
Breaking Medicine Technology: