Surgical airways for trauma patients in an emergency surgical setting: 11 years' experience at a teaching hospital in Japan.

PURPOSE: Airway management of trauma patients during emergency surgeries can be very difficult and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings.
METHODS: We performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, focusing on ESA.
RESULTS: During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5 %) required emergency surgery. Four of these patients (0.72 %) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and 1 patient with penetrating neck trauma received open standard tracheostomy (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes. Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale ≥3) received ESA at a significantly higher rate than others (p = 0.015, odds ratio 14.1).
CONCLUSION: One of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including providing ESA, to assure patient safety.