title: A novel role for otolaryngologists in the multidisciplinary Difficult Airway Response Team.
abstract: OBJECTIVE
  The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes.
  
  
  METHODS
  Retrospective review of prospectively collected data from the hospital's airway registry.
  
  
  METHODS
  We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach.
  
  
  RESULTS
  Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre-DART implementation to four (0.21%) post-DART implementation.
  
  
  CONCLUSIONS
  Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.forename: Vinciya
authors.initials: V
authors.lastname: Pandian
authors.forename: Lynette J
authors.initials: LJ
authors.lastname: Mark
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: Christina R
authors.initials: CR
authors.lastname: Miller
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Renee
authors.initials: R
authors.lastname: Cover
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Berkow
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.forename: Nasir
authors.initials: N
authors.lastname: Bhatti
mesh_terms: D058109:Airway Management / Q000379:methods*; D005260:Female; D057209:Hospital Rapid Response Team; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies
keywords: Difficult airway; cricothyrotomy; multidisciplinary airway team; oropharyngeal edema; patient outcomes