The preferences, experience and level of comfort of anaesthetists in managing difficult intubation and ‘cannot intubate, cannot ventilate’ scenarios

Abstract

Background: The “cannot intubate cannot ventilate” (CICV) scenario is a rare occurrence but can lead to significant morbidity and mortality if not managed appropriately. International data shows that anaesthetists lack knowledge of and fail to employ difficult airway algorithms. Method: A prospective, contextual, descriptive study was done to determine the preferences, experience and level of comfort of anaesthetists in the Wits Department of Anaesthesiology to manage difficult intubations and CICV situations. A previously validated questionnaire was adapted for local use and distributed to all available anaesthetists. Results: A total of 111 (88.1%) participants knew the location of the difficult airway trolley, but 43 (38.8%) stated that the trolley is not easily accessible. Ninety two (73%) participants preferred the videolaryngoscope as first choice device when facing a difficult airway. The predominant second choice devices were the flexible fibre-optic scope, chosen by 52 (43%) and the intubating laryngeal mask, chosen by 48 (38.1%). The majority of participants had no experience with the retrograde wire set, optical stylet and rigid bronchoscope. The most popular device for cricothyroidotomy, chosen by 47 (37.3%), was an IV cannula, but only 34.9% was comfortable with using this option. The majority of anaesthetists have no experience with the internationally recommended open surgical method. Sixty-three (50%) of the participants have experienced a CICV scenario in clinical practice. Conclusion: Airway training can be improved in our department. The location of the difficult airway trolley is not known by everyone and many believe that it is not readily available in an emergency. The videolaryngoscope is the preferred difficult airway device and the IV cannula the first choice in a CICV scenario. There is a significant difference in the comfort level of consultants and registrars with the use of most advanced airway devices.