NICE GUIDANCE in a Nutshell:
What is an unexpected difficult airway? An unexpected difficult airway is when a patient is expected to be intubated successfully without difficulty or complications and for reasons related to anatomy, disease or trauma is found to be difficult to intubate.
What is the incidence of difficult airway?
According to the NAP41 audit in UK, approx. 2% of all tracheal intubations will be difficult in each year. Tracheostomies also fall within the category of difficult airways and in an audit carried out by the National Tracheostomy Safety Project (NTSP)2 in UK, there were 276 critical incidences over a two year period caused by tracheostomy tubes becoming displaced.
What are the consequences of not being able to manage an unexpected difficult airway or dislodged tracheostomy?
If a patient cannot be intubated then they will either die, suffer a hypoxic injury or in the least suffer trauma to the larynx and pharynx due to the trauma caused by multiple attempts at intubation.
What is the current management of an unexpected difficult airway?
Algorithms and guidelines on how these events can be managed are published by the different anaesthesia or difficult airway societies. There are various tools available to manage the unexpected difficult airway. The gold standard is to use a flexible intubation scope. However, due to the expense, maintenance and constant sterilisation of a reusable, flexible endoscope, situations arise when patients are put at risk due to a scope not being available. Ambu aScope 2 helps departments and isolated sites address the issue of availability of flexible scopes in order to manage patient’s airways.
What is the Ambu aScope 2?
The Ambu aScope 2 is a single-use, sterile and disposable flexible scope. It is connected to the reusable aScope Monitor or Ambu aView monitor. The NICE guidance was published in July 2013, when the aScope 2 was the only version of aScope available. Ambu has subsequently launched the aScope 3 family of scopes to incorporate additional features and improvements to the earlier aScope 2 model.
What is NICE?
NICE stands for NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. NICE evidence-based guidelines help resolve uncertainty about which medicines, treatments, and devices represent the best quality care and which offer the best value for money for the NHS in UK. When a device or treatment is recommended, NICE promotes a guideline that sets a “standard of care”. Healthcare professionals are expected to take this guidance into account when exercising their clinical judgment.
What is the NICE guidance on aScope 2?
During 2012 and beginning of 2013 NICE evaluated the use of aScope 2 in regard to difficult airway management and in July 2013 NICE issued the NICE guidance MTG143 supporting the use of aScope 2. The conclusions were very simple: Adoption of the aScope 2 across all areas in hospitals where airways are managed (operating theatre, ICU, emergency room, maternity, etc) was likely to improve patient safety whilst simultaneously saving the NHS in UK money through the avoidance of costly harm to patients.
What are the NHS costs involved in not being able to manage a difficult airway successfully?
More details can be found within NICE’s ‘Costing Statement’ Document for Ambu aScope 2, but the NHS costs for a hypoxic brain injury in a general setting was found to be £378,000 and in an obstetric setting, £646,00. Litigation costs were typically £135,000 and prolonged ICU stays ranged from approx. £8,000 in failed intubation to approx. £20,000 for displaced tracheostomy. Other costs saving came from damage caused to reusable scopes and multiple other factors relating to staffing and equipment.
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