National Audit of all UK Ambulance Trusts Reveals Worrying Inconsistencies.
According to an article published in the British Journal of Anaesthesia, Hypoxia is the most common cause of airway related deaths1 and although serious injury is rare from airway management complications, 25% of anaesthesia-related deaths are in a ‘can’t intubate can’t ventilate’ (CICV) situation where an emergency surgical airway is required2.
Expertise in management of the airway is to some extent the prime clinical skill that defines anaesthetists, so what happens if the same scenario happens in a pre-hospital environment? A challenge faced by ambulance staff, and according to an article published in the journal of paramedic practice, one with a diversity and multitude of inconsistent options ranging from skill set to available airway equipment.
In 2015, a study was conducted into airway management through a national audit of all 14 UK ambulance services that revealed a range of employees with differing clinical grades, titles and skill sets. The study also highlighted that all ambulance services had a range of airway equipment but no common and consistent inventory. Furthermore, some of the basic equipment could be used by almost all staff, whereas a wider variation in who was suitable to perform more difficult techniques was also highlighted3.
Quite worryingly, it has also been discovered that unlicensed technique (cannula and 3-way tap with o2 canister) is being used and due to the width of the cannula, enables oxygenation for only 15 minutes, potentially limiting the chances of survival due to the restriction in time.
It’s unsettling to learn there were gaps in equipment discovered, meaning limited options in certain scenarios, and one example in particular emphasised the inadequacy of one particular service to offer advanced airway support to those below the age of 6 years3.
In conclusion of the study, it was pointed out that the range of airway equipment and the paramedics authorised to use it appeared to be evolving and that in order for patients to receive optimal airway management across the country, effort needs to be placed on implementing an evidence-based airway management policy across all UK ambulance services.
In a bid to assist in the development of advanced airway techniques and products available amongst UK ambulance services, Bristol based surgical equipment supplier Freelance Surgical has been working with a number of ambulance trusts providing them with free training and product knowledge in a CICO (Can’t intubate can’t oxygenate) scenario. Using simulators, cricothyroidotomy training is delivered with an ingenious piece of advanced airway kit called ‘Quicktrach II’. The wide bore cannula with metal needle eradicates the need to use a scalpel and enables ventilation with a resus bag in a matter of seconds. In addition, the attached cuff provides protection against aspiration. It is extremely effective and very safe to use, there is a safety ‘stopper’ that prevents the needle from being inserted too deep (reducing the risk of posterior tracheal wall perforation).
- Br J Anaesth (2012) 109 (suppl_1): i68-i85. Complications and failure of airway management T. M. Cook S. R. MacDougall-Davis
- Frerk C, Cook T. Cook TM, Woodall N, Frerk C. Management of the ‘can't intubate can't ventilate’ situation and the emergency surgical airway, Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society. Major Complications of Airway Management in the United Kingdom. Report and Findings , 2011 LondonRoyal College of Anaesthetists
- http://www.magonlinelibrary.com/doi/full/10.12968/jpar.2015.7.6.285 (Accessed 21/07/17)