Adam Rehak is a consultant anaesthetist at Royal North Shore Hospital and the coordinator of anaesthesia and airway training at the Sydney Clinical Skills and Simulation Centre (SCSSC). Creator of the ATTAAC airway management course, instructor on the CCAM course, and executive member of the ANZCA Airway Management Special Interest Group, Adam has been heavily involved in multidisciplinary airway management teaching for more than 10 years.
Emergency airway management…a team sport, not a technical skill
SMACC EMERGENCY MEDICINE UPDATES CONGRESS
Too often, quality airway management is equated solely with mastery of the specific requisite technical skills. While these are an undeniably critical component, the importance of other factors such as decision making, communication and team dynamics during emergency airway management is frequently overlooked.
We know from large observational data sets such as the National Emergency Airway Registry (NEAR) out of the US and the 4th National Audit Project in the UK, that morbidity and mortality is frequently attributable to judgement and communication rather than a failure of specific technical skills. Specifically, reviewed cases consistently involved i) persistence with intubation beyond a reasonable/acceptable number of attempts, ii) omission of, or failure to adequately optimise face-mask ventilation or supraglottic airway insertion as a rescue oxygenation technique, and iii) lack of clarity around when upper airway rescue should be declared failed, leading to delay, or even a failure to perform, CICO Rescue (eFONA).
A disproportionate amount of this morbidity and mortality is occurring out-of-hours, likely involving junior medical officers still finding their feet with both technically and with their leadership, communication and team-coordination skills. These latent weak-points in the system are unlikely to manifest when the airway proves to be straight-forward, but with unanticipated difficulty, and the involvement of team members from other disciplines (anaesthesia/surgery) problems become increasingly likely to arise.
Protocolisation of airway management through algorithms and checklists have gone someway to defending against these types of errors and omissions, but these are not always designed to promote improved team-performance through promotion of shared mental-models and inclusion of cognitive forcing strategies. This clinically-focused presentation will not only unpack how the non-technical factors described above contribute and impact emergency airway management, but also provide tools and an altered perspective to optimise team performance during these cases.