Two-Tiered Response for Emergency Airway Management by Respiratory Therapists and Anesthesiologists

Abstract

Introduction

Out-of-operating-room intubations carry the potential for serious morbidity and mortality and require the around-the-clock presence of personnel trained in emergency airway management.

Methods

We established a hybrid model for response to airway problems of an acutely ill patient population; in this model, respiratory therapists handled emergent intubations with telephone back up from anesthesiologists whereas the anesthesiologist came in to the hospital to handle urgent intubations. Emergent intubations are cases in which the patient was expected to require intubation in < 30 min. The model is based on an assessment that demonstrated that the most complex intubations are urgent rather than emergent. Following the training described, the model was put in place, and the results of the first 18 months are reported.

Results

One hundred sixty four out-of-operating-room intubations were required, including 89 cardiac arrest patients and 75 noncardiac arrest patients. Respiratory therapists intubated the majority of cardiac arrest patients whereas the majority of nonarrest situations were intubated by anesthesiologists. Intubation was successful in 162 of 164 patients; 2 failures occurred in cardiac arrest situations with a physician present but no anesthesiologist immediately available. However in both cases, the anesthesiologist who arrived also could not intubate.

Conclusions

This model permits the anesthesiologist to be available for the majority of intubations in the noncardiac arrest situation in which medical management and pharmacologic therapy are often required; whereas respiratory therapists perform the majority of intubations during cardiac arrest. This model is successful and resulted in economic savings.