title: Need for emergency surgical airway reduced by a comprehensive difficult airway program.
abstract: BACKGROUND
  Inability to intubate and ventilate patients with respiratory failure is associated with significant morbidity and mortality. A patient is considered to have a difficult airway if an anesthesiologist or other health care provider experienced in airway management is unable to ventilate the patient's lungs using bag-mask ventilation and/or is unable to intubate the trachea using direct laryngoscopy.
  
  
  METHODS
  We performed a retrospective review of a departmental database to determine whether a comprehensive program to manage difficult airways was associated with a reduced need to secure the airway surgically via cricothyrotomy or tracheostomy. The annual number of unplanned, emergency surgical airway procedures for inability to intubate and ventilate reported for the 4 yr before the program (January 1992 through December 1995) was compared with the annual number reported for the 11 yr after the program was initiated (January 1996 through December 2006).
  
  
  RESULTS
  The number of emergency surgical airways decreased from 6.5 +/- 0.5 per year for 4 yr before program initiation to 2.2 +/- 0.89 per year for the 11-yr period after program initiation (P < 0.0001). During the 4-yr period from January 1992 through December 1995, 26 surgical airways were reported, whereas only 24 surgical airways were performed in the subsequent 11-yr period (January 1996 through December 2006).
  
  
  CONCLUSIONS
  A comprehensive difficult airway program was associated with a reduction in the number of emergency surgical airway procedures performed for the inability of an anesthesiologist to intubate and ventilate, a reduction that was sustained over an 11-yr period. This decrease occurred despite an increase in the number of patients reported to have a difficult airway and an overall increase in the total number of patients receiving anesthesia per year.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 8-134, Baltimore, MD 21287, USA. lberkow1@jhmi.edu
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Berkow
authors.forename: Robert S
authors.initials: RS
authors.lastname: Greenberg
authors.forename: Kristin H
authors.initials: KH
authors.lastname: Kan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Lynette J
authors.initials: LJ
authors.lastname: Mark
authors.forename: Paul W
authors.initials: PW
authors.lastname: Flint
authors.forename: Marco
authors.initials: M
authors.lastname: Corridore
authors.forename: Nasir
authors.initials: N
authors.lastname: Bhatti
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Heitmiller
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000758:Anesthesia; D002983:Clinical Competence; D002985:Clinical Protocols; D003299:Cooperative Behavior; D003413:Cricoid Cartilage / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D011300:Preoperative Care; D015397:Program Evaluation; D012042:Registries; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy