Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants.
BACKGROUND
Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.


METHODS
From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.


RESULTS
A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).


CONCLUSIONS
Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.


BACKGROUND
NCT01718561.
Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark anderskehlet@hotmail.com.
A K
AK
Nørskov
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
J
J
Wetterslev
Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark.
C V
CV
Rosenstock
Department of Anaesthesiology, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
A
A
Afshari
Department of Anaesthesiology and Intensive care, Section South, Aarhus University Hospital, Aarhus 8000, Denmark.
G
G
Astrup
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark Department of Cardiology, Copenhagen University Hospital, Holbæk 4300, Denmark.
J C
JC
Jakobsen
Department of Anaesthesiology, Copenhagen University Hospital, Herlev Hospital, Herlev 2730, Denmark.
J L
JL
Thomsen
Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
M
M
Bøttger
Department of Anaesthesiology, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
M
M
Ellekvist
Department of Anaesthesiology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
B M B
BM
Schousboe
Department of Anaesthesiology, Bekkevold Private Hospital, Hellerup 2900, Denmark.
A
A
Horn
Department of Anaesthesiology, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg 2000, Denmark.
B G
BG
Jørgensen
Department of Anaesthesiology, Glostrup Hospital, Copenhagen University Hospital, Glostrup 2600, Denmark.
K
K
Lorentzen
Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark.
M H
MH
Madsen
Department of Anaesthesiology, Lillebælt Hospital, Kolding 6000, Denmark.
J S
JS
Knudsen
Department of Anaesthesiology, Copenhagen Private Hospital, Lyngby 2800, Denmark.
B K
BK
Thisted
Department of Anaesthesiology, Nykøbing Falster Hospital, Copenhagen University Hospital, Nykøbing Falster 4800, Denmark.
S
S
Estrup
Department of Anaesthesiology, South Jutland Hospital, Aabenraa 6200, Denmark.
H B
HB
Mieritz
Department of Anaesthesiology, South Jutland Hospital, Sønderborg 6400, Denmark.
T
T
Klesse
Department of Anaesthesiology, Private Hospital Kollund, Kollund 6340, Denmark.
H J
HJ
Martinussen
Department of Anaesthesiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
A G
AG
Vedel
Department of Anaesthesiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen 2400, Denmark.
R
R
Maaløe
Department of Anaesthesiology, Roskilde Hospital, Copenhagen University Hospital, Roskilde 4000, Denmark.
K B
KB
Bøsling
Department of Anaesthesiology, Næstved Hospital, Copenhagen University Hospital, Næstved 4700, Denmark.
P R C
PR
Kirkegaard
Department of Anaesthesiology, South Jutland Hospital, Haderslev 6100, Denmark.
C R
CR
Ibáñez
Department of Anaesthesiology, Thy-Mors Hospital, 7700 Thisted, Denmark.
G
G
Aleksandraviciute
Department of Anaesthesiology, Lillebælt Hospital, Vejle 7100, Denmark.
L S
LS
Hansen
Department of Anaesthesiology, Abdominal Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.
T
T
Mantoni
Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark.
L H
LH
Lundstrøm
D000328:Adult; D000368:Aged; D058109:Airway Management / Q000009:adverse effects / Q000379:methods; D016000:Cluster Analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017211:Treatment Failure
airway management; cluster analysis; preoperative care; randomized controlled trial