title: Surgical airway in emergency department intubation.
abstract: OBJECTIVE
  To determine the frequency of and primary indication for surgical airway during emergency department intubation.
  
  
  METHODS
  Prospectively collected data from all intubations performed in the emergency department from January 1999 to July 2007 were analysed to ascertain the frequency of surgical airway access. Original data were collected on a structured proforma, entered into a regional database and analysed. Patient records were then reviewed to determine the primary indication for a surgical airway.
  
  
  RESULTS
  Emergency department intubation was undertaken in 2524 patients. Of these, only five patients (0.2%) required a surgical airway. The most common indication for a surgical airway was trauma in four of the five patients. Two patients had attempted rapid sequence induction before surgical airway. Two patients had gaseous inductions and one patient received no drugs. In all five patients, surgical airway was performed secondary to failed endotracheal intubation attempt(s) and was never the primary technique used.
  
  
  CONCLUSIONS
  In our emergency department, surgical airway is an uncommon procedure. The rate of 0.2% is significantly lower than rates quoted in other studies. The most common indication for surgical airway was severe facial or neck trauma. Our emergency department has a joint protocol for emergency intubation agreed by the Departments of Emergency Medicine, Anaesthesia and Critical Care at the Edinburgh Royal Infirmary. We believe that the low surgical airway rate is secondary to this collaborative approach. The identified low rate of emergency department surgical airway has implications for training and maintenance of skills for emergency medicine trainees and physicians.
authors.affiliation: Department of Emergency, Edinburgh Royal Infirmary, Little France Crescent, Little France, Edinburgh, Scotland. lreid79@yahoo.co.uk
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Reid
authors.forename: Mark
authors.initials: M
authors.lastname: Dunn
authors.forename: Dermot W
authors.initials: DW
authors.lastname: Mckeown
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Oglesby
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012606:Scotland; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult