In this 121st episode I welcome Dr. Lynette Mark to the show. Dr. Mark is the founder of our Difficulty Airway Response Team (DART) here at Hopkins and a founding director for the Society of Airway Management. We discuss the origins of the DART program and how to approach a difficult airway.
CME: https://earnc.me/z1E2G1
References:
https://www.criticalcare.theclinics.com/article/S0749-0704(17)30102-1/abstract
Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC): http://sgschallenge.com/2018daarc/
https://wamm2019.com World Airway Management Meeting, Amsterdam, Netherlands, November, 2019. Drs. Mark and Feinleib will be presenting about the DART program.
Dr. Cooper’s article on surgical airway: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2724164
Dr. Mark’s article from A&A and the accompanying editorial:
Excellent episode, it is a classic example what can be done at a large center.
I work in a mid size european hospital setting and alas much of this is not practical.
We do flag all the patients that are deemed potentially problematic on the OR plan and protocols (the diff airway arm bands are a good idea that’s easy to implement) for the OR and we have video scopes and fibres directly available in all cases and the ICU anyway. Unless you are in a large centre emergency surgical airways are quite rare and we just have to rely on regular practice. I have made a practice phantom using a 3d printed model and some common hospital supplies (I had one printed at surprisingly high quality by Shapeways for $40) for tracheostomy that’s in the on call room and when it’s slow you can practice a few to get the mechanics and logistics down (get a scalpel and bougie/larger gi-tube/woodbridge 6 added to all the airway and code carts). I think this does help break the decision barrier to go to surgical airway early and not faff about when the other options are not working.
Episode 111 makes a excellent companion to this episode and Emcrit and AIME have some excellent info on this as well.
Hi Dr. Wolpaw – Such an interesting episode! I just started my first clinical rotation and have had a large focus on airway management. Thank you for your insight. Hope you’re doing well.
Thanks Meagan, good luck with your clinical rotations!