Vinciya Pandian1,2, Gooi Zhen3, Stanola Stanley1,2, Marco Oldsman1,2, Elliott Haut4,5,6, Lynette Mark7, Christina Miller7, Alexander Hillel8. 1. Johns Hopkins School of Nursing, Baltimore, Maryland. 2. Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland. 3. University of Chicago Medicine, Chicago, Illinois, U.S.A. 4. The Division of Acute Care Surgery, Department of Surgery; Department of Anesthesiology and Critical Care Medicine; Department of Emergency Medicine, Baltimore, Maryland. 5. The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland. 6. The Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 7. The Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland. 8. The Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Abstract
OBJECTIVE: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. METHODS: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. RESULTS: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. CONCLUSION: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1360-1367, 2019.
OBJECTIVE: The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients. METHODS: Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre-DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post-DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre-DART and post-DART cohort. RESULTS: The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post-DART cohort and 56% of the pre-DART cohort. The incidence of patients requiring intubation was higher in the post-DART cohort (18 out of 27 [67%]) than the pre-DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post-DART and pre-DART cohorts. CONCLUSION: Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic-guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:1360-1367, 2019.
Authors: Michael McCormick; Adam J Folbe; Ho-Sheng Lin; Joanna Hooten; George H Yoo; John H Krouse Journal: Laryngoscope Date: 2011-01-13 Impact factor: 3.325
Authors: W Robert Leeper; Elliott R Haut; Vinciya Pandian; Sajan Nakka; Jeffrey Dodd-O; Nasir Bhatti; Elizabeth A Hunt; Mustapha Saheed; Nicholas Dalesio; Adam Schiavi; Christina Miller; Thomas D Kirsch; Lauren Berkow Journal: J Surg Educ Date: 2018-04-05 Impact factor: 2.891
Authors: Brett J Carroll; Heather Pemberton; Kenneth A Bauer; Louis M Chu; Jeffrey L Weinstein; Barbara L Levarge; Duane S Pinto Journal: Am J Cardiol Date: 2017-07-26 Impact factor: 2.778