The following is a summary of “Incidence of rescue surgical airways after attempted orotracheal intubation in the emergency department: A National Emergency Airway Registry (NEAR) Study,” published in the June 2023, issue of Emergency Medicine by Offenbacher, et al.

Cricothyrotomy is a crucial procedure in the emergency department (ED) to manage a failed airway. However, since the introduction of video laryngoscopy, there has been limited information on the incidence and indications for rescue surgical airways performed when orotracheal or nasotracheal intubation attempts were unsuccessful. For a study, researchers sought to determine the incidence and reasons for performing rescue surgical airways by analyzing data from a multicenter observational registry.

A retrospective analysis was conducted on cases of rescue surgical airways in patients aged 14 years and above. Patient characteristics, clinician details, airway management information, and outcomes were examined.

Among the 19,071 subjects in the registry, 17,720 (92.9%) were 14 years or older and had undergone at least one initial orotracheal or nasotracheal intubation attempt. Of these, 49 patients required a rescue surgical airway attempt, resulting in 2.8 cases per 1,000 (0.28% [95% CI 0.21 to 0.37]). The median number of airway attempts before performing the rescue surgical airway was 2 (interquartile range 1, 2). Among the cases, 25 were trauma victims (51.0% [36.5 to 65.4]), with neck trauma being the most common indication for the procedure (n = 7, 14.3% [6.4 to 27.9]).

Rescue surgical airways were infrequently performed in the ED, with a rate of 0.28% (0.21 to 0.37). Approximately half of these procedures were performed in trauma cases. The findings had implications for the acquisition, maintenance, and experience of surgical airway skills in emergency medicine.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000888