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A Survey of Residency Directors in Academic Trauma Centers for Policies on Airway Management in the Trauma Ward

Author(s): George L Tewfik, Michal Gajewski, Jena Salem, Neil Borad, Michael Zales, Gopal Govindaraj

Background: Despite its presence as a critical procedure in the trauma setting, airway management is not performed uniformly, varying between institutions, particularly with personnel involved in decision-making. Past literature has noted a trend in which emergency medicine physicians assumed greater responsibility for primary management of airways in the trauma ward. Many institutions have adopted tiered activation systems for traumas in order to improve patient care, deploying resources more effectively.

Methods: In this study, a survey of residency directors was deployed to assess trends in airway management. A validated survey was distributed to residency directors in anesthesiology, general surgery and emergency medicine in 190 Level I trauma centers in the United States. Questions assessed personnel management, complication tracking and difficult airway prediction factors, amongst other considerations for airway management in the trauma bay.

Results: Respondents completed the survey at a rate of 23.8% of those solicited. A majority of respondents indicated that emergency medicine physicians are primary airway managers in the trauma bay and that their institutions utilize tiered trauma activation systems at 77.4% and 95.6% respectively. Anesthesia providers were immediately available in 81% of respondent institutions with inconclusive data regarding protocols for delineating anesthesia involvement in difficult airways. More than a third of respondents indicated their institution either does not track airway complications or they did not know if complications were tracked. Finally, nine different criteria were used in varying degrees by respondents’ institutions to predict the presence of a difficult airway, including such factors as head/face trauma, airway fluid and obesity.

Conclusions: Emergency medicine physicians are the primary airway managers in many trauma centers, although they are often supported by the presence of anesthesiology for advanced airway interventions. Delineation of anesthesia involvement is unclear, and criteria to determine a difficult airway varies amongst institutions.

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