A survey of practice among doctors in India belonging to different specialities towards peripheral tracheal intubation calls

Introduction: Airway management in critically ill patients in emergency room and periphery wards is an essential component of resuscitation and is considered a high-risk procedure with one or more complications occurring in 22–54% of all intubations performed. As there are few hospitals in India with dedicated emergency physician available, the airway management in emergencies and peripheral wards is done by residents pooled from various specialities. This survey was conducted with objective to assess the challenges encountered during tracheal intubation in emergency settings outside the controlled environment of operation theatre and to know the complications occurring during airway management in these scenarios. Further assessment was conducted with objectives to assess the challenges and dilemma faced by them and to know complications and outcomes associated airway management in these cases. Materials and Methods: An anonymous 30 questions survey was sent online to 500 doctors from different branches in India as online google forms via email. Data pertaining to respondent demographics, practice characteristics (including availability of resources, medications and equipment’s) were collected and analysed descriptively using different frequencies and percentages and Fisher’s exact tests followed by post hoc multiple comparisons. Results: 248 residents filled up the questionnaire, 78% were anaesthesiologists, and rest were from different medical branches. Ninety-seven percentage felt the need for display of protocol regarding the guidelines for intubation and cardiopulmonary resuscitation in emergency and periphery locations. All participants felt the need for teaching residents from all specialities to manage peripheral intubation calls. Conclusions: Airway management at periphery locations is challenging and needs the implementation of algorithms including the new airway devices. Finally, the standard airway guidelines for difficult airway management remain the cornerstone of managing and securing airway at periphery for obvious reasons, although some specific aspects can be adapted in specific scenarios. Introduction In emergency room (ER) and peripheral wards, securing the airway by tracheal intubation is an essential component of resuscitation in sick patients. Compared to elective intubation in operating theatre (OT), this procedure poses unique problems as the patients, indications and degree of urgency is remarkably different. As a result, the incidence of failed intubation in these locations is much higher. The incidence of failed intubation among anaesthetists in United States in controlled environment of OT is 0.05-0.35%, whereas in emergency setting the incidence is 1-2% with repeated attempts in laryngoscopy being required in 5-20%. There is paucity of such data from studies in Indian scenario. In western countries, emergency medicine is a well-developed medical speciality and airway management in the peripheral locations is mostly undertaken by physicians trained in Emergency Medicine (EM) department. The scenario in India and other low and middle-income countries is different where EM is still a nascent speciality. All India Difficult Airway Association previously laid down guideline on airway management of intensive care unit (ICU) patients and recently Difficult Airway Society from United Kingdom published guidelines for intubation in critically ill patients. We feel that airway management in nonOT and non -ICU locations is far more challenging especially in developing countries like India as it is done frequently by residents of various specialities and anaesthesiologists are called upon as specialist in these cases. With non-existence dedicated EM team in most hospitals and scarcity of teaching and training in managing these cases in anaesthesia curriculum, the challenge of tracheal intubation in these locations is increased manifold. Article Info Received: 6th March, 2019 Accepted: 22nd May, 2019 Published Online: 22nd August, 2019