An An audit of difficult airway trolleys at central and tertiary hospitals affiliated with the University of the Witwatersrand. A cross-sectional study.
Evaluation of Difficult airway trolleys
DOI:
https://doi.org/10.51168/kkz7tj91Keywords:
Airway Trolleys, Central and Tertiary Hospitals, WitwatersrandAbstract
Background:
Airway management equipment is essential for mitigating morbidity and mortality associated with difficult airway complications in anaesthesia (Apfelbaum et al., 2013). This study audited the availability, physical structure, contents, and maintenance of difficult airway trolleys (DATs) and grab bags across four South African central and tertiary hospitals against United Kingdom Difficult Airway Society (DAS) guidelines.
Methods:
A prospective, contextual, descriptive cross-sectional audit was conducted across four university-affiliated academic hospitals in Gauteng, South Africa. DATs and grab bags were evaluated against DAS criteria using a validated REDCap® checklist assessing location, physical structure, drawer labelling, equipment completeness, algorithm display, routine checking systems, and grab bag availability. Data were analysed using descriptive statistics.
Results:
Fifteen DATs were audited across 21 theatre complexes comprising 72 operating theatres. Eleven trolleys (73.3%) were concentrated at a single hospital, while two hospitals possessed only one trolley each. While 14 trolleys (93.3%) were fully mobile, only seven (46.7%) were logically stocked, and two (13.3%) lacked drawer labelling entirely. None of the DATs (0.0%) met complete DAS guidelines for top, side, or drawer contents. Video laryngoscopes and flexible fibreoptic scopes were universally absent on DATs. Cognitive airway algorithms were displayed on six trolleys (40.0%), and only one hospital utilised locally agreed guidelines. Difficult airway grab bags were available at two hospitals (50.0%) but lacked surgical cricothyroidotomy equipment.
Conclusions:
A substantial deficiency exists in the quantity, stocking logic, labelling, and content standardisation of DATs across public academic hospitals relative to surgical volume.
Recommendations:
Institutional management must prioritise standardising DAT contents according to validated algorithms, establishing mandatory daily checking logs, procuring video-assisted airway equipment, and deploying localised cognitive decision aids across all clinical areas where anaesthesia is administered.
References
1. Adams, T.R. and Piper, B.J. (2019) 'Northern Territory difficult airway trolley audit', Anaesthesia and Intensive Care, 47(4), pp. 397–398. Available at: https://doi.org/10.1177/0310057X19854462.
2. Apfelbaum, J.L., Hagberg, C.A., Caplan, R.A., Blitt, C.D., Connis, R.T., Nickinovich, D.G. et al. (2013) 'Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists task force on management of the difficult airway', Anesthesiology, 118(2), pp. 251–270. Available at: https://doi.org/10.1097/ALN.0b013e31827773b2.
3. Armstrong, L., Harding, F., Critchley, J. et al. (2020) 'An international survey of airway management education in 61 countries', British Journal of Anaesthesia, 125(1), pp. e54–e60. Available at: https://doi.org/10.1016/j.bja.2020.04.051.
4. Australian and New Zealand College of Anaesthetists (ANZCA) (2021) Guideline on equipment to manage difficult airways. Australia: ANZCA. Available at: https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper (Accessed: 7 February 2021).
5. Baker, P.A., Hounsell, G.L., Futter, M.E. and Anderson, B.J. (2007) 'Airway management equipment in a metropolitan region: An audit', Anaesthesia and Intensive Care, 35(4), pp. 563–569. Available at: https://doi.org/10.1177/0310057X0703500416.
6. Bjurström, M.F., Bodelsson, M. and Sturesson, L.W. (2019) 'The difficult airway trolley: A narrative review and practical guide', Anesthesiology Research and Practice, 2019, p.6780254. Available at: https://doi.org/10.1155/2019/6780254.
7. Brink, H., Van Der Walt, C. and Van Rensburg, G. (2006) Fundamentals of Research Methodology for Health Care Professionals. 2nd edn. Cape Town: Juta.
8. Burns, N. and Grove, S.K. (2009) The Practice of Nursing Research. 6th edn. St. Louis: Saunders Elsevier.
9. Caplan, R.A., Posner, K.L., Ward, R.J. and Cheney, F.W. (1990) 'Adverse respiratory events in anesthesia: A closed claims analysis', Anesthesiology, 72(5), pp. 828–833. Available at: https://doi.org/10.1097/00000542-199005000-00010.
10. Cook, T.M., Woodall, N. and Frerk, C. (2011) 'Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia', British Journal of Anaesthesia, 106(5), pp. 617–631. Available at: https://doi.org/10.1093/bja/aer058.
11. Cook, T.M., Woodall, N., Harper, J. and Benger, J. (2011) 'Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: Intensive care and emergency departments', British Journal of Anaesthesia, 106(5), pp. 632–642. Available at: https://doi.org/10.1093/bja/aer059.
12. Difficult Airway Society (2018) Setting up a Difficult Airway Trolley (DAT). United Kingdom: Difficult Airway Society. Available at: https://das.uk.com/content/difficult_airway_trolley (Accessed: 7 February 2021).
13. Edelman, D., Perkins, E. and Brewster, D. (2019) 'Difficult airway management algorithms: A directed review', Anaesthesia, 74(9), pp. 1175–1185. Available at: https://doi.org/10.1111/anae.14779.
14. Fuchs, A., Haller, M., Riva, T., Nabecker, S., Greif, R. and Berger-Estilita, J. (2021) 'Translation and application of guidelines into clinical practice: A colour-coded difficult airway trolley', Trends in Anaesthesia and Critical Care, 40, pp. 46–54. Available at: https://doi.org/10.1016/j.tacc.2021.06.007.
15. Hodgson, R.E., Milner, A., Barrett, D., Alberts, A., Joubert, I. and Hold, A. (2008) 'Airway management resources in operating theatres: Recommendations for South African hospitals and clinics', Southern African Journal of Anaesthesia and Analgesia, 14(3), pp. 1–10. Available at: https://doi.org/10.1080/22201173.2008.10872545.
16. Janssens, M. and Hartstein, G. (2001) 'Management of difficult intubation', European Journal of Anaesthesiology, 18(1), pp. 3–12. Available at: https://doi.org/10.1046/j.0265-0215.2000.00777.x.
17. Udeh, C.I., Udeh, B.L. and Dalton, J.E. (2016) 'Estimating the number of difficult airway carts needed in an operating suite: Resource planning without compromising patient safety', Journal of Clinical Anesthesia, 31, pp. 106–110. Available at: https://doi.org/10.1016/j.jclinane.2016.01.008.
18. Williamson, J.A., Webb, R.K., Szekely, S., Gillies, E.R. and Dreosti, A.V. (1993) 'Difficult intubation: An analysis of 2000 incident reports', Anaesthesia and Intensive Care, 21(5), pp. 602–607. Available at: https://doi.org/10.1177/0310057X9302100518.
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