Difficult Airway Response Team (DART) and Airway Emergency Outcomes: A Retrospective Quality Improvement Study

• Published in: Otolaryngology-head and neck surgery Vol. 169; no. 2; pp. 325 - 332
• Main Authors: Kuhar, Hannah N., Bliss, Alessandra, Evans, Kimberly, Besecker, Beth, Spitzer, Carleen, Lyaker, Michael, Schofield, Minka
• Format: Journal Article
• Language: English
• Published: England 01.08.2023
• Subjects: Airway Management; airway response team; Anesthesiologists; Critical Care; difficult airway; emergency airway; Humans; Intubation, Intratracheal; multidisciplinary team; Otolaryngologists; Quality Improvement; Retrospective Studies; emergency airway; multidisciplinary team; difficult airway; airway response team
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1002/ohn.358

Objective Difficult airways can be associated with significant morbidity and mortality, particularly in the event of a delay in securing the airway. To improve the airway metrics at our institution, we implemented a multidisciplinary team of airway providers to respond to difficult and emergent airways, or the Difficult Airway Response Team (DART). The purpose of the present study is to assess the feasibility of a DART program at a tertiary care center. Study Design A retrospective study evaluating the outcomes of emergent airway cases using the DART protocol. Setting Single tertiary academic care center. Methods In August 2019, a DART program was implemented at a tertiary academic medical center. In order to assess the feasibility and effectiveness of this system, data were collected to assess DART outcomes through chart review and surveys following each event, and analyzed in Microsoft Excel. Results A total of 161 DART events (average 4.6/month) took place from August 2019 to June 2022. Anesthesiologists secured the airway in 71 events (51%), otolaryngologists in 38 (27%), and pulmonary/critical care in 12 (9%). Seventy‐three activations were not labeled as a difficult airway. Pre‐DART, 19 cases required more than 3 attempts to secure the airway compared to 11 cases after DART. Transoral intubation was the most common intervention. Thirteen cases required surgical intervention. Conclusion Implementing a multidisciplinary team‐based approach for managing emergent difficult airways at a tertiary care institution was feasible and resulted in a decreased number of airway attempts in difficult airway patients. Continuous process improvement is essential for the ongoing enhancement of DART systems.