Article(s) of the month, July 2021
Dear EAMS members and airway friends,
IntubateCOVID is an observational study on how the clinicians managed the intubation procedure in COVID -19 infected patients. Data was collected from 32 countries (607 institutions, 4,476 intubations) with different economical level, most of the procedures being from ICUs.
The authors found differences on first-attempt success depending on the equipment that clinicians used, the operator’s previous intubating experience and the economical level of the country.
It offers some clues on how to manage the intubation procedure in future airway related pandemics.
Hope you find it interesting!
Xavier Onrubia
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EAMS Webinar June 2021
The June 2nd EAMS webinar dealt with airway management in the critically ill patients.
Prof. Vincenzo Russotto and Prof Sheila Myatra presented the results of the "INternational observational study To Understand the impact and BEst practices of airway management in critically ill patients (INTUBE study)".
It is a large multicentre study across five continents that highlights how frequent complications are while performing airway management procedures, identifies those complications.
Finally, the speakers, moderators and audience discuss possible measures to prevent and treat them.
Don´t miss the webinar if you have not watched it yet!
Ana Isabel Pereira, Paula Chiesa and Massimiliano Sorbello
Article(s) of the month, June 2021
Dear airway enthousiast:
This month's EAMS article of the month and webinar focus on critically ill patient's airway management, since the most commonly performed procedures in these patients are related with airway management, including tracheal intubation and tracheostomy. [1]
Firstly, the “DAS Guidelines for the management of tracheal intubation in critically ill patients” [2] provide strategies to optimize oxygenation, airway management, and tracheal intubation in these patients, in all hospital locations. These guidelines stress the importance of human factors for improved outcomes of emergency airway management: the role of the airway team, a shared mental model, planning, and communication throughout airway management.
Secondly, the recently published observational multicenter: “Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries” [3] concluded that major adverse events occur frequently. The reported adverse events in patients undergoing emergency intubation are: cardiovascular instability, severe hypoxemia, and cardiac arrest.
Furthermore, to deepen our understanding of these adverse events, previous studies where Janz et al [4] and Russel et al [5] explore possible measures to prevent cardiovascular collapse secondary to intubation are included.
Finally, with the aim of preventing hypoxemia Casey et al [6] focus on the advantages and disadvantages of face mask ventilation and, Jaber et al [7], discuss the preferred intubation devices in this setting.
Enjoy reading and looking forward to the webinar!
Paula Chiesa
EAMS Webinar May 2021
The EAMS Webinar entitled “HFNO and COVID-19 - where are we in spring 2021?” was held on the 6 of May 2021.
This webinar covered high flow nasal oxygen delivery during COVID-19 and the physics behind droplet and aerosol formation.
Prof. Patel discussed HFNO in the covid era and presented the evidence now available to understand the safety of its use. He debated about the degree to which HFNO is aerosol generating and the associated risk of pathogen transmission.
Prof. Barnes explained the physics of aerosols and droplets: how they behave, are formed and spread from our organism to the environment. Finally, he provided a physicist conclusion about droplets and aerosols and COVID 19.
Corresponding literature is also available for EAMS members on the web page.
See you at our next webinar!
Ana Isabel Pereira, Tino Greif and Paula Chiesa
Article(s) of the month, May 2021
Dear EAMS members and airway enthusiasts,
We are still fighting this pandemic COVID-19 and the last year has shown us the importance of obesity as an independent risk factor for the severity of COVID-19.
The articles of this month focus on implications for mechanisms, comorbidities, prognosis and some key points to optimise airway management and ventilation for obese patients in such challenging times!
Recent studies have shown that obesity is associated with the severity of coronavirus disease. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. (articles 1&2)
Some key points to optimize airway management, noninvasive and invasive mechanical ventilation in ICU patients with obesity are suggested in articles 3 & 4.
Enjoy the reading and keep safe!
Kind regards,
Daniela Godoroja- Diarto
EAMS Webinar March 2021
The EAMS Webinar entitled “Difficult Airway: Improving our patient´s safety” was held on the 31 of March 2021.
Dr. Fiona Kelly from Bath in the UK described human factors and ergonomics and their components and key roles in airway management. “The Airway Spider” recently published was introduced and practical advice to incorporate these principles into our clinical work were given.
Dr. Iljaz Hodzovic form Cardiff in the UK showed a realistic and meticulous describing video on awake videolaryngoscope guided intubation. The preparation of the patient, the operating theatre and team was described in details too. Topicalization, proper positioning and the choice of device were discussed as mentioned in the recently published DAS guidelines on awake intubation.
This great learning experience by two outstanding engaging speakers is now available for EAMS members on the members space.
See you at our next webinar!
Tino Greif and Paula Chiesa
Article(s) of the month, April 2021
Dear airway enthusiastics,
We are still fighting this pandemic and the number of patients keep increasing also in pediatric patient group even if they are not symptomatic but still contagious.
Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease.
Hope this article will help all of us in airway management in pediatric group of patients during this, somehow, unending pandemia.
Best regards,
Prof. Dr. Özgür Canbay
HUFM/Anesthesiology/TURKEY
Article(s) of the month, March 2021
Dear EAMS members and fellow airway enthusiasts,
These last twelve months have shown us the importance of resilience and great teamwork in making the difference in such challenging and unique times!
Crisis occurs while taking care of patients and managing their airways in time pressured and highly risky procedures. Both technical skills and human factors are the safe ground for a successful teamwork.
The articles of this month focus on the basal pillars of human factors, resilience and teamwork and how they can improve airway management safety.
Enjoy the reading and keep safe & well!
Ana Isabel Pereira
EAMS Webinar, February 2021
Dear members,
We are happy to share with you our last webinar "Particularities of airway management in tracheostomized patients”.
The aim of this webinar is to increase our knowledge and confidence in taking care of tracheostomized patients. For this purpose, two experts discuss from the basic principles of tracheostomy to the specific needs and wishes of patients with a tracheostomy.
They finally clarify the treatment of emergencies in tracheostomized patients.
The topic aroused great interest among the audience, who sent very interesting questions on percutaneous tracheostomy and anesthesia for these procedures that were explained in detail by the experts.
For further information and access to the video data recording and articles provided by the speakers please log in using your membership credentials. If not, become a member!
Don't miss the webinar if you have not seen it yet!!
Ana Isabel Pereira, Tino Greif and Paula Chiesa
Article(s) of the month, February 2021
Dear airway enthusiasts,
This month’s article is a recently published paper in Lancet about video laryngoscopy in small infants.
In this multicenter, randomised controlled trial, the primary outcome was the proportion of patients with successful orotracheal intubation on the first attempt. Secondary outcomes were number of intubation attempts; time to successful orotracheal intubation; proportion of unsuccessful intubations with the randomly assigned device; and proportion of non-severe and severe complications.
A nice comparison of video laryngoscopy and direct laryngoscopy in routine, non-emergency intubations under ideal conditions.
Have fun reading the full text in: https://www.eamshq.net
With best wishes
Kemal Tolga Saracoglu, Prof MD DESA FEAMS
Treasurer
Article(s) of the month, January 2021
Dear colleagues,
We lovingly greet you in this really difficult period for our work, in which we must increasingly think not only about the health of our patients, but also about our safety.
“Unfortunately” we work in a regional reference hospital for Covid-19 and we are particularly attentive to the safety of us doctors and our collaborators, risking to make us consider ourselves too apprehensive, at times...
We use the aerosol box, video laryngoscope and the most valid individual protection devices. Thanks to this approach, at the moment we have not registered any cases of infection in healthcare personnel.
Here are two recent articles that validate our clinical practices are good quality mannequin-based simulation studies.
The first highlights strengths and weaknesses of the “aerosol box”, an economic and optimizable device to be used not only in the intubation phase but also in nursing management.
The second compares two protective equipments on difficult airway management through the use of different instruments for intubation.
Looking forward to meeting you at the next congress, when all this is over.
Rosa Gallo
Francesco Maiarota
-Cosenza Hospital Italy-
Article(s) of the month, December 2020
Dear airway management enthusiasts,
I hope you are all healthy during these difficult times.
As articles of the month, you will find two recently published studies that deal with High Flow Nasal Oxygenation:
1. Z.M. Piosik, et al look into the safe limits of apneic oxygenation as before the onset of respiratory alkalosis.
2. T.Riva, et al, explore the importance of positive airway pressure in the maintenance of oxygenation in a randomized controlled trial.
Enjoy reading!
Paula Chiesa
EAMS Webinar, November 2020
Dear fellow airway management enthusiasts,
Our 2nd EAMS webinar took place this week on November 10th and it was about “Ultrasound Application for Airway Management”. The speakers Dr. Stefano Falcetta (University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy), Dr. Domagoj Damjanovic (University Heart Center Freiburg-Bad Krozingen, Dept. Of Cardiovascular Surgery, Freiburg, Germany) and Prof. Dr. Rakesh Garg (Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India) discussed with the moderators Dr. Ana Isabel Pereira (Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal) and Professor Dr. Robert Greif (Bern University Hospital, Bern. Switzerland) about the powerful tool and broad use of ultrasound to evaluate and predict difficult airways, to assist airway related procedures (like FONA) and to access correct intubation and proper placement of supraglottic devices.
For further information and access to the video data recording and articles provided by the speakers please log in using your membership credentials. If not, become a member!
Next webinar will take place in January 2021! More information soon!
Ana Isabel Pereira and Robert Greif
EAMS Webinar, September 2020
Dear airway management enthusiasts,
After the summer break, EAMS started again with webinars.
The first was last week on 24 September about the “Usefulness of aerosol boxes and barrier enclosures for airway Management to prevent infection during the COVID-19 pandemic”. The speakers Prof. Dr. William Rosenblatt (Yale Medicine Anesthesiology. New Haven. USA) and Prof. Dr. Felipe Urdaneta (University of Florida. Gainesville. USA) discussed with Professor Dr. Robert Greif, (Bern University Hospital, Bern. Switzerland) and Dr. Massimiliano Sorbello (Policlinico San Marco University Hospital, Catania, Italy) about the lack of evidence for the effectiveness of these barriers and the additional risk these methods might bring for the patient and the personnel in the OR during airway management. As no scientific evidence exist that these methods prevent infection they are by no measn a substitute for proper PPE.
The Discussion was based on a recent publication in the BJA entitled: “Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. M Sorbello, W Rosenblatt, R Hofmeyr, R Greif, F Urdaneta."
For those who are interested in more details about the webinar and the article please use your member log-in.
Robert Greif
Article of the month, November 2020
Dear colleagues,
I hope you are healthy and happy in this odd, new and unusual world.
In my department, I work as a pediatric anesthetist at Hacettepe University Hospital, we keep taking urgent and of course emergency cases during this period by taking safety measures. Video laryngoscopes as a most significant step of these safety measures, gained very much importance .
Videolaryngoscopes are useful in tracheal intubation in adults and in children, but it is not clear whether or not there are differences in efficacies between the different types of video laryngoscopes in children.
I have read the following two articles, one is editorial, interestedly. Although derived from retrospective analysis, these findings of Peyton and colleagues'make a useful contribution to our understanding of device performance across paediatric patients.
1. Peyton J, Park R, Staffa SJ, et al; PeDI Collaborative Investigators. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry.
2. Norris A, Armstrong J. Comparative videolaryngoscope performance in children: data from the Pediatric Difficult Intubation Registry.
Wish you healthy days,
Özgür Canbay
Article(s) of the month, October 2020
Dear airway management enthusiasts,
After the summer break, EAMS started again with webinars.
The first was last week on 24 September about the “Usefulness of aerosol boxes and barrier enclosures for airway Management to prevent infection during the COVID-19 pandemic”. The speakers Prof. Dr. William Rosenblatt (Yale Medicine Anesthesiology. New Haven. USA) and Prof. Dr. Felipe Urdaneta (University of Florida. Gainesville. USA) discussed with Professor Dr. Robert Greif, (Bern University Hospital, Bern. Switzerland) and Dr. Massimiliano Sorbello (Policlinico San Marco University Hospital, Catania, Italy) about the lack of evidence for the effectiveness of these barriers and the additional risk these methods might bring for the patient and the personnel in the OR during airway management. As no scientific evidence exist that these methods prevent infection they are by no measn a substitute for proper PPE.
The Discussion was based on a recent publication in the BJA entitled: “Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. M Sorbello, W Rosenblatt, R Hofmeyr, R Greif, F Urdaneta."
For those who are interested in more details about the webinar and the article please use your member log-in.
Robert Greif
Article(s) of the month, September 2020
Dear airway enthusiastic friends,
Although there are many articles related to airway management in this time of COVID -19 era, my interested turned to a bit different choice to share with you- of course related to what I know best: Obese Airway management. It refers to not one but to two correspondences in BJA, related to airway trauma in critically ill obese patients due to COVID-19 .
1.Tracheal trauma after difficult airway management in morbidly obese patients with COVID-19
2.Tracheal introducers and airway trauma COVID-19.
As we face the new worldwide pandemic of COVID-19, it was clearly suggested that a serious potential risk factor for infection development with severe disease progression is obesity. Simonnet et al mentioned that approximately 85% of patients with obesity required mechanical ventilation and other preliminary data from New York City showed that obesity (BMI>40 kg/m2) is the second strongest independent predictor of hospitalization, after old age (preprint by Petrilli et al.)
The first paper exemplified that patients with severe obesity with a typical presentation of SARS-CoV-2 infection, requiring invasive ventilationafter failing noninvasive oxygen therapy presented difficult tracheal intubation and the use of a bougie probably induced tracheal trauma thereby worsening the respiratory condition and leading to urgent ECMO.
The second paper has come on behalf of the airway experts as a response to the first paper and give advice about the optimising oxygen delivery before intubation to allow more controlled airway management especially in hypoxaemic obese patients. The likelihood of successful tracheal bougie placement with a Grade IV laryngeal view is quite low, whereas the risk of airway trauma as a result of blind bougie insertion is significant, so that use of a bougie in such a scenario is considered contraindicated.
The appropriate use of this simple device remains a precious adjunct for airway management in conjunction with direct or video-laryngoscopy, especially in difficult airway management patients such as obese patients.
Please enjoy!
Dani Godoroja
Article(s) of the month, August 2020
Hi, my dear airway enthusiastic friends.
A lot of papers run into my head to be selected for “article of the month”.
I finally decided to present you this one:
Tracheostomy in the COVID-19 era: global and multidisciplinary guidance
Three reasons directed me to this choice
- The interest of the topic in this COVID-19 pandemic. There have been published a lot of papers on tracheostomy in the COVID-19 patient by several scientific societies and working groups coming from different medical disciplines, mainly Head and Neck surgery, Critical Care, and Anaesthesiology. This paper tries to summarize all opinions.
- The multidiscipline and international composition of the group of authors (30), most of them known experts on the topic, coming from (in alphabetical order) Australia, China, France, Germany, Italy, Spain, Switzerland, UK and USA
-The accurate update of the paper (24 references from a total of 45 were published in 2020 and 2 more papers were “in press”)
There is an excellent summary of recommendations about patient selection, timing of tracheostomy, performance and management after procedure
I hope you enjoy this paper.
Xavi Onrubia
Article(s) of the month, July 2020
Dear EAMS members and airway enthusiasts,
July’s article of the month consists of a narrative review of the Front of Neck Access (FONA) from well renowned airway experts.
The management of a Cannot Intubate-Cannot Oxygenate (CI-CO) scenario is extremely challenging and one of the anaesthesiologist's fields of expertise. The authors mention that “the concept of FONA covers a large amount of techniques, principles, problems and debates”. The review discusses the epidemiological and technical aspects about CI-CO.
Although only a few will ever perform a cricothyrotomy during their careers, always remember the 7 Ps: Proper Planning, Preparation and Practise Prevents Poor Performance!
Enjoy this Summer reading in the EAMS Journal Trends in Anaesthesia and Critical Care!
Keep safe and well!
Ana Isabel Pereira
Article(s) of the month, June 2020
Dear colleagues,
I hope you manage to stay well and healthy and are still able to get to some reading done in this crazy year. Flexible endoscopic intubation has been praised as the standard technique for expected difficult intubations by numerous international guidelines. Current literature suggests that this is an easy technique with a high success rate and low complication rate. However, having taught flexible endoscopic intubations at workshop skill stations throughout the world, I found that anesthesiologists' skills in this technique are often inadequate. There seems a significant disconnect between published literature and clinical reality.
In this month's manuscript, Dr. Grange et al. examined the experience with flexible intubation in the UK. They show what others already knew: one of the critical skills in anesthesiology is not as frequently used as it should be, the complication rate does not seem to match the published data.
Enjoy the read in the EAMS journal TACC!
Best wishes,
Rudy Noppens
COVID-19 and Airway Management - Documents and Links
Documents and Links
Article(s) of the month, May 2020
Consensus guidelines for managing the airway in patients with COVID-19
Iljaz Hodzovic
Article(s) of the month, April 2020
OUTBREAK OF A NEW CORONAVIRUS. WHAT ANAESTHETISTS SHOULD KNOW BJA 2020
Robert Greif
Article(s) of the month, April 2020
THE ITALIAN CORONAVIRUS DISEASE 2019. OUTBREAK ANAESTHESIA 2020
Robert Greif
Article(s) of the month, March 2020
AWAKE INTUBATION
March moth’s articles comes as a pair: Two 2020-papers (epub ahead of print 2019) that have to be read in conjunction: Ahmad and co-workers review on multiple aspects and practical guidance for AWAKE INTUBATION – The cornerstone technique in managing the predicted difficult airway, plus our accompanying editorial that reminds us that if an awake intubation is indicated then we shouldn’t abandon it easily – but remember that a spontaneous-ventilating intubation may be a close second best.
Enjoy!
Michael Seltz Kristensen
https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14904
Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults [published online ahead of print, 2019.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/anae.14947
Aziz MF, Kristensen MS. From variance to guidance for awake tracheal intubation [published online ahead of print, 2019.
Article of the month, February 2020
Comment:
The most stressful situation for an anaesthesiologist may be a No intubate/No oxigenate (NINO) patient. A recent study (NAP 4) says that in spite of the fact that all algorithms have a strategy for this situation- in all of them cricotirotomy is the final solution-, the resolution is not good in most of them. Why is this? How could we correct the mistakes that arise?. Simulation has proven to be an effective tool to improve how crisis resources are managed, such as NINO patient and CPR. It allows mistakes to be analyzed and solutions found, thus improving our performance. But, what if we have a NINO patient on whom we are performing cardiopulmonary resuscitation? This study by Ott et al (BMJ 2019) tries to address this question by establishing a possible airway management situation that, however infrequent, must not be forgotten. We hope you enjoy reading it.
Pedro Charco Mora
Ott T, Stracke J, Sellin S, et al. Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms. BMJ Open 2019;9:e030430. doi:10.1136/bmjopen-2019-030430
Open acces link (january 23th, 2020): https://bmjopen.bmj.com/content/9/11/e030430.info
Article of the Month(s) | January 2020
Dear airway enthusiasts,
This month’s article is a from Fiadjoe et al. about pediatric normal and difficult airway management. If you are curious about the following questions you have to read the full text:
- • What are cognitive biases observed in pediatric difficult airway management?
- • What are the strengths and weaknesses of videolaryngoscopes and flexible bronchoscopes for tracheal intubation?
- • What is the current evidence for spontaneous versus controlled ventilation techniques when managing the anticipated difficult airway?
- • What is the role of passive oxygenation in difficult airway management in the OR and pediatric ICU?
- • What is the current evidence regarding the use of neuromuscular blockade in neonatal tracheal intubation and difficult airway in children?
Have fun at http://eamshq.net
Kemal Tolga Saracoglu
Welcome letter from the new President, Michael Seltz Kristensen
Dear EAMS member! Dear co-airway-afficionado!
It is an honour to take over this position as President of EAMS!
The “European” in “European Airway Management Society” is not meant geographically!
It is meant to describe a European approach based on multiple inputs, discussion and best evidence, accepting different needs and resources, and based on human diversity.
Therefore, we are a true GLOBAL society, with members, You!, from all parts of the world.
EAMS Survey on Videolaryngoscopes
Dear EAMS members
We invite you to take the European Airway Management Society Survey about Videolaryngoscopes.
Please click on the banner below.
Thank you!
