Pediatric Difficult Airway Equipment in Emergency Departments: A regional audit

 
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Qian Chen*, Mohamedabbas Jaffer**, Katia Florman***, Stephani Bernard****, Victoria Rainsley*****, Trisha Radia******
School of Clinical Medicine, King’s College London, UK*, School of Clinical Medicine, King’s College London, UK**, School of Clinical Medicine, King’s College London, UK***, Department of Paediatrics, Guy’s and St Thomas’ NHS Foundation Trust, UK****, Department of Paediatrics, Guy’s and St Thomas’ NHS Foundation Trust, UK*****, Department of Paediatrics, Guy’s and St Thomas’ NHS Foundation Trust, UK******
Abstract
Introduction
The 4th National Audit Project (NAP4) by the Royal College of Anaesthetists highlighted that difficult intubation accounts for 9% of all intubations in the emergency departments (EDs). (1) It subsequently recommends that all paediatric EDs should have a difficult airway trolley (DAT) dedicated to paediatric use. The 2012 emergency care standard by RCPCH [5] also specified a list of recommended airway equipment in emergency situations. Previous surveys demonstrated a general low availability of paediatric DAT in anaesthetics departments (16%) (2) and PICU/HDUs (42%). (3) This regional audit aims to survey the availability of paediatric DAT and difficult airway equipments in London paediatric emergency units.

Method
A standard questionnaire for DAT and difficult airway equipments was devised according to the RCPCH guideline [4]. Data was collected from senior nursing staff in all 34 London paediatric EDs via telephone, email or in person.

Results
30 out of 34 units were included. 40% have paediatric DAT on the unit although all units have some difficult intubation equipments. A significant number of departments do not have capnography recording (23%), cuffed ETT of all sizes (33%), and cricoidotomy set (33%). Variation in the choice of laryngeal blades reflects individual preferences by specialists. 90% units keep a daily checking rota.

Discussion
Adhering to the standards set by the NAP4 and RCPCH is important for the provision of standardised and safe care. Certain flexibility should be allowed for specialised equipments choices. Daily checking is essential. We also suggest the College of Emergency Medicine to publish further guidelines.

Conclusion
This survey highlights the need for improved availability of paediatric DAT and intubation equipments. Particular effort should be made to secure the more advanced equipments, and ensure the availability of a full size range for basic equipments.
References :
  1. Major Complications of Airway Management in the United Kingdom, the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011
  2. Khan et al. Paediatric Difficult Airway Trolley Survey. Association of Paediatric Anaesthetists Peninsula Meeting Torquay. 2011
  3. Khan et al. Nationwide survey of Difficult Airway Trolleys in Paediatric Intensive Care, 24th Annual meeting of the European Society of Paediatric and Neonatal Intensive Care.
  4. Standards for Children and Young People in Emergency Care Settings 2012, RCPCH

DOI: 10.7199/ped.oncall.2014.22S
 
How to Cite URL :
Chen Q, Jaffer M, Florman K, Bernard S, Rainsley V, Radia T.. Available From : http://www.pediatriconcall.com/conference/abstract/33/view/828
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