Devices for difficult airway management in academic emergency departments:Results of a national survey

Study objective: We conducted a national survey of emergency medicine resid ency program directors to determine which alternative devices were availabl e in their emergency departments for difficult airway management. We also a ssessed the residency directors' experience in use of these devices. Methods: After approval was received from the institutional review board at our institution, residency directors were contacted by mail, fax, or phone in October 1997. Alternative intubation devices were defined as devices th at do not involve use of a laryngoscope and direct visualization for trache al tube placement. Alternative ventilation devices were defined as those th at do not use a face mask for ventilation. We asked whether the following a lternative intubation devices were stocked in their department: a flexible fiberoptic bronchoscope, a rigid fiberoptic device tie, Bullard, Wu-Scope), a lighted stylet, or a retrograde intubation kit. We also asked;about the following alternative ventilation devices: a transtracheal jet Ventilation system with a 50-psi oxygen source and control valve, the esophageal trache al twin-lumen airway device (Combitube), or the laryngeal mask airway. Resi dency directors were also questioned about their duration of practice, intu bation experience, and use of these devices. Results: We obtained information from 95 of 118(81%)programs. Of 95 program s, 61 (64%) had a fiberoptic bronchoscope, 43 (45%) a retrograde intubation kit, 33 (35%! a lighted stylet, and 6 (.06%) a rigid fiberoptic device. Fo rty-seven (49%) of the programs reported 2 or more devices, and 20 (21%) re ported having no alternative intubation devices. Of 95 programs, 64 (67%) h ad a transtracheal jet ventilation system, 25 (26%) had the Combitube, and 25 (26%) had the laryngeal mask. airway. Thirty-one (33%) programs had at l east 2 alternative ventilation devices, and 20 (21%) had none. Ten (11%) pr ograms had no alternative intubating or ventilation devices. Additional inf ormation on duration of practice, intubation experience, and actual use of alternative devices was obtained from 83 of the 95 (87%) emergency medicine residency directors contacted. Forty-one (49%) reported never having used an alternative device for intubation. The most commonly used alternative in tubation device was the flexible fiberoptic bronchoscope (37%), and the mea n number of times any alternative device was used was 7. Conclusion: The availability of devices for difficult airway management var ies tremendously across emergency medicine residency programs. Only half of residency program directors had any experience with these devices, and amo ng those that reported any experience, they are used rarely.