Episode 62: Defining Airway Management Success
In collaboration with
A PODCAST LECTURE BY GEORGE KOVACS
25/10/22
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SPEAKER Bio
DR GEORGE KOVACS
Dr. George Kovacs is a full-time professor of Emergency Medicine and is cross-appointed in the Department of Anaesthesia, Department of Medical Neuroscience and Division of Medical Education at Dalhousie University. He works clinically as an Emergency Physician and Trauma Team Leader at the Queen Elizabeth II Health Sciences Centre in Halifax. He is Medical Director of Lifeflight, the Provincial critical care transport program. He holds a Masters of Health Professions Education from the University of Illinois where he developed his interest in procedural skill learning and is the Director of the Clinical Cadaver Program at Dalhousie. He is an award-winning educator who co-developed the internationally recognized airway education program (Airway Interventions & Management in Emergencies- AIME). He has four children and in addition to his passion for airway management education he loves being at his cottage on the Medway river spending time with his two loves of his life, his family and his Massey Ferguson tractor.
LECTURE SUMMARY
Airway management in the ED and other acute care settings has followed the ‘ABC’ priority paradigm. Open the airway, apply oxygen then support oxygenation and ventilation with a ‘definitive’ airway A.K.A a tracheal tube. The challenge and focus of airway management in emergencies has been on the technical imperative of laryngoscopy and intubation and therefor success is usually referenced by correct placement of the tube. First pass success (FPS) has been the primary outcome in a majority of publications examining airway management. This reverse rationalization is supported by numerous publications in every setting demonstrating an association between increasing number of attempts and patient morbidity and mortality. The focus of airway management is to support oxygenation and ventilation while maintaining physiologic homeostasis. The tube provides neither benefit nor harm airway management and success should therefor, be defined by a broader contextual surrogate for patient outcomes. Clinicians should strive for FPS rates >90%, without critical hypoxemia or hypotension performed in a timely manner.
lEARNING OBJECTIVES
Upon completion of this activity, you should be able to:
Understand the benefits and risks of using first pass success as an outcome measure for airway management in emergencies
Understand the importance of a broader contextual physiologically focused definition of airway management success
Motivate airway providers to practice and train as teams to perform safe airway management
Encourage providers to record, evaluate and re-evaluate quality performance measures beyond first pass success