• Guidelines - NAP4
  Link:www.rcoa.ac.uk/system/files/CSQ-NAP4-Full.pdf
  
• Clinical themes
• Poor airway assessment contributed to poor outcomes
• Lack of strategy in dealing with difficult airways
• Failure to plan for failure
• Events where supraglottic airways used inappropriately
• AFOI underused when indicated
• Difficult intubation managed by repeat attempts deteriorate into CICV.
• SADs used to avoid tracheal intubation in some patients with a recognised difficult intubation
• Anaesthesia for head/neck featured highly
• Obesity was poorly recognised as a risk factor
• High failure rate of emergency cannula Cricothyroidotomy
• Aspiration the single commonest cause of death
• Failure to interpret capnography led to oesophageal intubations
• 1/3 of events occurred in emergence or recovery
• 1/4 of incidents were from ITU or A&E
• Failure to use capnography in ventilated patients contributed to 70% of ITU related deaths
• Displaced tracheostomy was a leading cause of mortality on ITU
• Most events in AED were as a consequence of RSI
• Recommendations based on these findings exhaustive
• All departments should have an explicit policy for managing difficult airways
• Plan should be in place prior to induction
• Assessment for risk of aspiration must be thorough
• Extubation should be managed optimally
• Airway management plan conveyed to recovery staff
• Capnography should be used for intubation of all critically ill patients
• Training of staff in capnography interpretation
• Intubation checklist developed
• ITU should have algorithms for displaced tracheostomies
• Regular audit should take place
• Securing the airway before anaesthesia should be considered
• If Cricothyroidotomy may be needed, consider placing this prior to induction
• AFOI can fail and a back up plan should be thought in advance
• Those who work together should train together