The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Phil Genovese1

Background: Standardization of equipment and processes increase both efficiency and effectiveness and has a positive impact on patient safety and outcomes. One such example is standardizing equipment in difficult airway carts to give the competent practitioner the ability to follow the American Society of Anesthesiologists "Difficult Airway Algorithm."

Many variables, including budget constraints and unique patient care needs, may prohibit difficult airway carts from being standardized throughout a hospital and may require that carts are standardized by patient population or unit needs. For example, at Mayo Clinic Arizona (MCA), the difficult airway carts in the Emergency Department, the Operating Room, and the Intensive Care Unit (ICU) have similar equipment and supplies but are slightly different based on patient needs.

It is important to note that any cart will only be as good as the practitioners' ability to use the equipment. Studies have found that adequate airway management requires skills such as decision making, communication, leadership and team cooperation. At MCA, residents, respiratory therapists, and ICU nurses participate in the Fundamental Critical Care Support (FCCS) program. The FCCS course is an initiative of the Society of Critical Care Medicine and includes training in medical assessment, critical thinking and team work. The program includes presentations and practice sessions on airway management to help familiarize participants with a variety of airway equipment.

The role of the respiratory therapist during a difficult airway situation is to know the contents of the cart, how to use the equipment efficiently, and to assist the physician as needed. Therapists need to be familiar with primary and alternative airway strategies including laryngeal mask airways (LMA), fiber-optic intubation, esophageal-tracheal combitube and transtracheal jet ventilation. Respiratory Departments should include training in the use of the alternative equipment in annual competencies and promote the development of the team skills and communication essential to successfully solve "cannot intubate-cannot ventilate" scenarios.

In addition to working with the equipment, therapists may be asked to assist with designing and obtaining contents for difficult airway carts. Therapists may also be responsible to ensure equipment is available and working properly, to check expiration dates and replace expired items and to replenish the cart after each use.