Major Complications of Airway Management

Airway management is, of course, a cornerstone of safe anaesthetic practice. Major complications occur only infrequently but their impact is devastating and their incidence is unknown in the UK. The opportunity to learn from a detailed analysis of a cohort of such cases has never existed before.

The 4th National Audit Project (NAP4) is an ambitious project being conducted jointly by the Royal College of Anaesthetists (RCoA) and the Difficult Airway Society (DAS) in co-operation with the National Patient Safety Agency (NPSA) with the aim of discovering the incidence of serious airway complications and examining each reported case for common themes and learning points.

This project closely follows the model used for the successful NAP3 audit of central neuraxial blockade.

Starting on 1st of September 2008 and running for one year, it will determine the incidence of major complications of airway management in the UK. To achieve this objective it will be necessary to undertake a snapshot of current airway management practice, providing the denominator, followed by a year-long data collection of major complications to provide a numerator.

There is good evidence that major complications of airway management are not restricted to routine anaesthesia and many of the most difficult airway management challenges occur in the emergency department (ED) and the intensive care unit (ICU). For this reason, the audit is collaborating with the College of Emergency Medicine (CEM) and the Intensive Care Society (ICS) and wish all major complications of airway management (whether cared for by anaesthetists or other specialties) that occur in theatres the ED and ICU to be reported to NAP4.

A formal report of the project will be published by the RCoA and DAS in mid 2010. This will include quantitative analysis (incidence calculations) and an analysis of cases identified. This will be in the form of clinical review seeking learning points and cross specialty education. The findings will be sent to all those who have assisted in the project.

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