Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.
Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Anaesthesia. 2018 Jun;73(6):703-710. doi: 10.1111/anae.14247. Epub 2018 Mar 13.
In this exploratory study we describe the utility of smartphone technology for anonymous retrospective observational data collection of emergency front-of-neck airway management. The medical community continues to debate the optimal technique for emergency front-of-neck airway management. Although individual clinicians infrequently perform this procedure, hundreds are performed annually worldwide. Ubiquitous smartphone technology and internet connectivity have created the opportunity to collect these data. We created the 'Airway App', a smartphone application to capture the experiences of healthcare providers involved in emergency front-of-neck airway procedures. In the first 18-month period, 104 emergency front-of-neck airway management reports were received; 99 (95%) were internally valid and unique from 21 countries. Eighty-one (82%) were performed by non-surgeons and 63 (64%) were 'cannot intubate, cannot oxygenate' emergencies. Overall first-attempt success varied by technique; 45 scalpel-bougie cricothyroidotomy (37 first-attempt success), 25 surgical cricothyroidotomy (15 first-attempt success), eight cannula cricothyroidotomy (five first-attempt success), six wire-guided cricothyroidotomy (three first-attempt success) and 15 tracheostomy reports (11 first-attempt success). The most commonly reported positive human factors were good communication, good teamwork and/or skilled personnel. The most commonly reported negative human factors were fixation on multiple tracheal intubation attempts, delay in initiating emergency front-of-neck airway and/or the failure to plan for failure. Due to the anonymous nature of reporting, reports are open to recollection bias and spurious reporting. We conclude collection of data using a smartphone application is feasible and has the potential to expand our knowledge of emergency front-of-neck airway management.
在这项探索性研究中，我们描述了智能手机技术在匿名回顾性观察性数据采集中的应用，用于紧急前颈部气道管理。医学界仍在争论紧急前颈部气道管理的最佳技术。尽管个别临床医生很少进行此操作，但全球每年仍有数百例。无处不在的智能手机技术和互联网连接为收集这些数据创造了机会。我们创建了“Airway App”，这是一款智能手机应用程序，用于捕获参与紧急前颈部气道程序的医疗保健提供者的经验。在前 18 个月期间，收到了 104 份紧急前颈部气道管理报告；99 份（95%）在内部是有效的，并且来自 21 个国家的报告是独特的。81 份（82%）由非外科医生进行，63 份（64%）为“无法插管，无法供氧”的紧急情况。总体而言，首次尝试的成功率因技术而异；45 例刀 - 气管造口术（37 次首次尝试成功），25 例外科气管造口术（15 次首次尝试成功），8 例套管气管造口术（5 次首次尝试成功），6 例导丝引导气管造口术（3 次首次尝试成功）和 15 例气管切开术报告（11 次首次尝试成功）。报告中最常提到的积极人为因素是良好的沟通、良好的团队合作和/或熟练的人员。报告中最常提到的消极人为因素是对多次气管插管尝试的关注、延迟启动紧急前颈部气道和/或未能计划失败。由于报告的匿名性质，报告容易受到回忆偏差和虚假报告的影响。我们得出的结论是，使用智能手机应用程序收集数据是可行的，并且有可能扩大我们对紧急前颈部气道管理的认识。
