Have you had a highly challenging airway situation in the ICU or the emergency department? Did it lead to a major adverse event? If so you are not alone, as the NAP4 report demonstrates:
Although there is no denominator, and a direct comparison with operating theatre events was not a purpose of the report, the message is clear: airway catastrophes, often leading to death, occur time and again in out-of-theatre locations. There seem to be many reasons, and we are left to speculate – suboptimal equipment, out-of-hours timing of the events, severely compromised patients, but perhaps simplest of all – poor patient positioning on soft beds rather than hard, adjustable operating tables. Much is made of the fragmentary availability of EtCO2 in these locations. Perhaps more importantly, lack of specialized airway training, and lack of continuing clinical practice in advanced airway management (i.e. clinical anesthesia) is also a proposed problem for some ED clinicians and intensivists. Indeed, some experts are suggesting that the trend towards earlier specialisation into intensive care and the development of an ICU training scheme entirely independent of anesthesia will only lead to an increase in such airway events,
Whatever your views, this is essential reading for everyone in our speciality (and many others!).