Navigation Links
Need for emergency airway surgery for hard-to-intubate patients reduced
Date:11/17/2009

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
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
Source:Eurekalert

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:
*Name:
*Comment:
*Email:
(Date:5/27/2017)... ... 27, 2017 , ... From May 21-23, hearing healthcare professionals gained a competitive ... at the Marriott Syracuse Downtown Hotel in Syracuse, New York. , As EarQ’s ... hearing healthcare providers to help them stay ahead in the industry. At the event, ...
(Date:5/26/2017)... ... May 26, 2017 , ... Leading CEOs from biotech, ... 30th and 31st at The Four Seasons Hotel Boston. , The Boston ... sciences, offering exclusive access to key decision makers who influence deal making and ...
(Date:5/26/2017)... ... May 26, 2017 , ... A new analysis of ... the healthiest seniors are located in the Midwest. With the average cost of healthcare ... people are concerned with both the quality and affordability of where they live. An ...
(Date:5/26/2017)... ... ... After raising nearly $30,000 on Kickstarter , about three-times its original ... discounted crowdfunding price on Indiegogo . , “Along with creating an anti-stress gadget ... a fidget toy to the market that was made of superior quality and wouldn’t ...
(Date:5/26/2017)... ... May 26, 2017 , ... Dr. Alex Rabinovich, a highly-skilled ... a new, informational blog post on insurance options. If a Bay Area patient has ... help save time and money. Visiting an in-network provider for a second opinion can ...
Breaking Medicine News(10 mins):
(Date:5/22/2017)... N.Y. , May 22, 2017  Lilac ... treatment Gene-Eden-VIR/Novirin, announces the launch of a ... English, the results of a clinical study that ... year treatment with Gene-Eden-VIR/Novirin in individuals suffering from ... to note that there are no other treatments ...
(Date:5/15/2017)... , May 15, 2017  Amy Baxter MD, ... industry leader in noninvasive pain relief, was awarded a ... magazine. Baxter was recognized at the MM&M Top ... New York City on May 10, 2017. ... the biopharma industry go "beyond the pill."  ...
(Date:5/10/2017)... May 10, 2017 Hologic, Inc. (Nasdaq: ... for the fiscal second quarter ended April 1, 2017 ... $1.84 increased 666.7% compared to the prior year period ... in a significant gain, while non-GAAP diluted EPS of ... or 3.8% in constant currency terms.  Excluding the effects ...
Breaking Medicine Technology: