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Safe airway management can involve awake endotracheal intubation. The NAP4 Study (http://www.rcoa.ac.uk/nap4) prospectively collected airway complications in the United Kingdom over a one-year period. It showed despite awake intubation being indicated for the patients' circumstances, but the practitioner did not perform an awake technique. This resulted in multiple complications including deaths in multiple patients.
Why are awake techniques not performed when indicated? Awake techniques are generally taught using individual trial-and-error approaches. Practitioners may recall very uncomfortable patient experiences or complications in the past during awake intubation attempts. Multiple techniques are recommended or taught usually based on experience, training or strong opinion. There is little evidence to guide one technique over another.
Any infrequently performed techniques are difficult to maintain and perform when required. Performing awake intubation successfully on the first attempt can be anxiety-provoking for the practitioner, but potentially life-saving for the patient. Not a procedure to be left to trial-and-error.
What technique(s) work best?
We want to help decrease practitioner anxiety and increase patient safety by crowd-sourcing data about awake techniques globally, and sharing what works and what doesn't during awake intubation.
What Does The airway App Record About Your Awake Intubation?
Our app records the details of your experience of either performing or witnessing first-hand an awake endotracheal intubation. The awake intubation can be either during an emergency situation or non-emergency such as for a planned surgical procedure.
Aside from the country where the awake intubation took place, all data is collected anonymously.
As this is an anonymous secure world-wide quality improvement project, our local Ethics council determined ethics approval is not required.
This Is Really Important Because
Uncertainty is scary and may be fraught with complications for our patients. Traditional medical research methods don't support capturing infrequent procedures in a sufficient way. New technology and collaboration can circumvent this in an inexpensive, credible and confidential way: The Airway App.
WANT TO BENEFIT FROM DATA-SHARING?
Information will be collected for a two-year period.
The Airway App is easy to fill out. It takes 2-3 minutes and, aside from what country your awake intubation took place in, is entirely anonymous.
Awake intubation results from The Airway App will be updated on this page every two months.
From time to time essential articles related to awake intubation will also be posted on our Current Literature page.
Why look at awake endotracheal intubation?
Not every patient benefits from inducing general anesthesia/ performing rapid sequence intubation prior to endotracheal intubation. Practice patterns are changing in Emergency Medicine and Intensive Care to recognize that the physiologic difficult airway can be as scary if not more so than the anatomically difficult airway. In such patients, it is becoming recognized that you have one attempt and often only one attempt, and there is emerging literature to demonstrate increasing complications and in some cases mortality with subsequent attempts. As such, we believe that more and more, Emergency Physicians and Intensivists will be turning to awake intubation, often using video laryngoscopy. It is no longer a technique only for anesthesiologists. So why shouldn't we collaborate to discover HOW best to do this high-risk, infrequent technique?