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A survey of Canadian anesthesiologists' preferences in difficult intubation and "cannot intubate, cannot ventilate" situations

David T Wong, Arpan Mehta, Amanda D Tam, Brian Yau, Jean Wong
Canadian Journal of Anaesthesia, Journal Canadien D'anesth├ęsie 2014, 61 (8): 717-26
24866377

INTRODUCTION: The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and "cannot intubate, cannot ventilate" (CICV) situations.

METHODS: A questionnaire was e-mailed to members of the Canadian Anesthesiologists' Society to ascertain their preferences, experience, and comfort level with regard to their use of airway equipment in difficult intubation and CICV situations in adult patients. A Chi square test was used to analyse the data. All reported P values are two-sided.

RESULTS: Nine hundred ninety-seven of 2,532 questionnaires (39%) were returned. In an unanticipated difficult direct laryngoscopic intubation situation, 893 of 997 (90%) respondents chose a video laryngoscope as the first-choice rescue technique, while 41 (4%) and 21 (2%) of respondents chose a flexible bronchoscope and an intubating laryngeal mask airway device, respectively. The majority of anesthesiologists had experience and were comfortable with using a flexible bronchoscope or a video laryngoscope. Regarding CICV, 294 of 955 (31%) respondents stated that they had never encountered it. Wire-guided cricothyroidotomy was chosen as the first-choice surgical airway by 375 of 955 (39%) respondents, while intravenous catheter cricothyroidotomy and "defer to tracheostomy by surgeon" were selected by 266 (28%) and 215 (23%) respondents, respectively. Seven hundred eighty-five of 997 (78%) respondents were familiar with the exact steps of the American Society of Anesthesiologists' difficult airway algorithm, while 448 (47%) had attended an airway workshop within the past five years.

CONCLUSIONS: In a difficult intubation situation, the most frequently selected first-choice airway device was a video laryngoscope, followed by a flexible bronchoscope. In a CICV situation, the most frequently selected first-choice surgical airway technique was a wire-guided cricothyroidotomy, followed by an intravenous catheter cricothyroidotomy.

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