Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees

Laura Goodwin; Katie Samuel; Behnaz Schofield; Sarah Voss; Stephen J Brett; Keith Couper; Doug Gould; David Harrison; Ranjit Lall; Jerry P Nolan; Gavin D Perkins; Jasmeet Soar; Matthew Thomas; Jonathan Benger; Research and Audit Federation of Trainees (RAFT) network

doi:10.1177/1751143720949458

Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees

J Intensive Care Soc. 2021 Aug;22(3):192-197. doi: 10.1177/1751143720949458. Epub 2020 Aug 18.

Authors

Laura Goodwin¹, Katie Samuel², Behnaz Schofield¹, Sarah Voss¹, Stephen J Brett³, Keith Couper^{4

5}, Doug Gould⁶, David Harrison⁶, Ranjit Lall⁴, Jerry P Nolan^{4

7}, Gavin D Perkins^{4

5}, Jasmeet Soar², Matthew Thomas⁸, Jonathan Benger^{1

8}; Research and Audit Federation of Trainees (RAFT) network

Affiliations

¹ Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
² North Bristol NHS Trust, Bristol, UK.
³ Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK.
⁴ Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
⁵ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁶ Intensive Care National Audit and Research Centre (ICNARC), London, UK.
⁷ Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
⁸ University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

Abstract

Background: The optimal airway management strategy for in-hospital cardiac arrest is unknown.

Methods: An online survey and telephone interviews with anaesthetic and intensive care trainee doctors identified by the United Kingdom Research and Audit Federation of Trainees. Questions explored in-hospital cardiac arrest frequency, grade and specialty of those attending, proportion of patients receiving advanced airway management, airway strategies immediately available, and views on a randomised trial of airway management strategies during in-hospital cardiac arrest.

Results: Completed surveys were received from 128 hospital sites (76% response rate). Adult in-hospital cardiac arrests were attended by anaesthesia staff at 40 sites (31%), intensive care staff at 37 sites (29%) and a combination of specialties at 51 sites (40%). The majority (123/128, 96%) of respondents reported immediate access to both tracheal intubation and supraglottic airways. A bag-mask technique was used 'very frequently' or 'frequently' during in-hospital cardiac arrest by 111/128 (87%) of respondents, followed by supraglottic airways (101/128, 79%) and tracheal intubation (69/128, 54%). The majority (60/100, 60%) of respondents estimated that ≤30% of in-hospital cardiac arrest patients undergo tracheal intubation, while 34 (34%) estimated this to be between 31% and 70%. Most respondents (102/128, 80%) would be 'likely' or 'very likely' to recruit future patients to a trial of alternative airway management strategies during in-hospital cardiac arrest. Interview data identified several barriers and facilitators to conducting research on airway management in in-hospital cardiac arrest.

Conclusions: There is variation in airway management strategies for adult in-hospital cardiac arrest across the UK. Most respondents would be willing to take part in a randomised trial of airway management during in-hospital cardiac arrest.

Keywords: Airway management; cardiac arrest; in-hospital cardiac arrest; supraglottic airway; tracheal intubation.