Effects of age on emergency airway management
1Department of radiology, Taitung MacKay Memorial Hospital, 95054 Taitung, Taiwan
2MacKay Junior College of Medicine, Nursing, and Management, 11260 Taipei, Taiwan
3Department of Medical Research, Taitung MacKay Memorial Hospital, 95054 Taitung, Taiwan
4Department of Emergency Medicine, Mackay Memorial Hospital, 10449 Taipei, Taiwan
5Department of Medicine, Mackay Medical College, 25245 New Taipei, Taiwan
6Institute of Mechatronic Engineering, National Taipei University of Technology, 10652 Taipei, Taiwan
7Department of Life Science, Fu-Jen Catholic University, 24205 New Taipei City, Taiwan
DOI: 10.22514/sv.2020.16.0109 Vol.17,Issue 2,March 2021 pp.127-131
Published: 08 March 2021
† These authors contributed equally.
Background/Purpose: Age is considered a risk factor for a difficult airway (DA) and can serve as guidance towards a quick decision in the management of an emergency airway. However, the effect of age on a DA is seldom evaluated. This study investigated the effect of age on the difficulty of emergency airway management to anticipate DAs, which would allow physicians to provide alternative approaches beforehand, thereby increasing the quality of emergency airway management in elderly patients.
Methods: A study form that recorded potential risk factors for a DA was designed. Research nurses and physicians who had performed tracheal intubation completed a case report form in the emergency department of a medical centre for over a year. Risk factors for a DA were identified using logistic regression.
Results: We recorded 114 attempts during the study period. Difficult mask ventilation (60.9% vs 10.0%, P < 0.001), but not difficult intubation (29.7% vs 22.0%, P = 0.355), was more frequently observed among elderly people compared with nonelderly patients.
Conclusion: Physicians should anticipate difficult mask ventilation in emergency airway management, especially in elderly people, and patients with sunken cheeks or a short and thick neck.
Anatomy; Aging; Airway management; Difficult airway; Difficult mask ventilation; Difficult intubation; Elderly; Emergency airway management; Endotracheal intubation
Sho-Ting Hung,Jerry Cheng-Yen Lai,Wen-Han Chang,Hui-Chun Ku. Effects of age on emergency airway management. Signa Vitae. 2021. 17(2);127-131.
 Cook TM, MacDougall-Davis SR. Complications and failure of airway management. British Journal of Anaesthesia. 2012; 109: i68-i85.
 Cook TM, Woodall N, Harper J, Benger J. Fourth National Audit Project. Major complications of airway management in the uk: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. part 2: intensive care and emergency departments. British Journal of Anaesthesia. 2011; 106: 632-642.
 Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, et al. The difficult airway with recommendations for management-part 1-difficult tracheal intubation encountered in an unconscious/induced patient. Canadian Journal of Anaesthesia. 2013; 60: 1089-1118.
 Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, et al. The difficult airway with recommendations for management-part 2-the anticipated difficult airway. Canadian Journal of Anaesthesia. 2013; 60: 1119-1138.
 Chien LC, Hsu HC, Lin CH, Cheng CF, Tung YC, Hung HC, et al. Use of an intubating laryngeal mask airway on out-of-hospital cardiac arrest patients in a developing emergency medical service system. Journal of the Formosan Medical Association. 2012; 111: 24-29.
 Arne J, Descoins P, Fusciardi J, Ingrand P, Ferrier B, Boudigues D, et al. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. British Journal of Anaesthesia. 1998; 80: 140-146.
 Karkouti K, Rose DK, Wigglesworth D, Cohen MM. Predicting difficult intubation: a multivariable analysis. Canadian Journal of Anaesthesia. 2000; 47: 730-739.
 Reed M, Dunn M, McKeown D. Can an airway assessment score predict difficulty at intubation in the emergency department? Emergency Medicine Journal. 2005; 22: 99-102.
 Langeron O, Cuvillon P, Ibanez-Esteve C, Lenfant F, Riou B, Le Manach Y. Prediction of difficult tracheal intubation: time for a paradigm change. Anesthesiology. 2012; 117: 1223-1233.
 Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Canadian Journal of Anaesthesia. 1994; 41: 372-383.
 Moon HY, Baek CW, Kim JS, Koo GH, Kim JY, Woo YC, et al. The causes of difficult tracheal intubation and preoperative assessments in different age groups. Korean Journal of Anesthesiology. 2013; 64: 308-314.
 Cho J, Cho YS, You JS, Lee HS, Kim H, Chung HS, et al. Current status of emergency airway management for elderly patients in Korea: multicentre study using the korean emergency airway management registry. Emergency Medicine Australasia. 2013; 25: 439-444.
 Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000; 92: 1229-1236.
 Gautam P, Gaul TK, Luthra N. Prediction of difficult mask ventilation. European Journal of Anaesthesiology. 2005; 22: 638-640.
 Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. Journal of Anesthesia. 2005; 19: 7-11.
 Lee SY, Chien DK, Huang MY, Huang CH, Shih SC, Wu KM, et al. Patient-specific factors associated with difficult mask ventilation in the emergency department. International Journal of Gerontology. 2017; 11: 263-266.
 Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006; 105: 885-891.
 Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009; 110: 891-897.
 Rocke DA, Murray WB, Rout CC, Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology. 1992; 77: 67-73.
 Johnson KN, Botros DB, Groban L, Bryan YF. Anatomic and phys-iopathologic changes affecting the airway of the elderly patient: impli-cations for geriatric-focused airway management. Clinical Interventions in Aging. 2015; 10: 1925-1934.
 Komasawa N, Minami T. Difficult airway management in a patient with combined severe deep neck abscess and acute epiglottitis with abscess. Journal of Clinical Anesthesia. 2014; 26: 581.
 Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthetic Surgery Journal. 2006; 26: S4-9.
 Lee SY, Shih SC, Leu YS, Chang WH, Lin HC, Ku HC, et al. Implications of age-related changes in anatomy for geriatric-focused difficult airways. International Journal of Gerontology. 2017; 11: 130-133.
 CEPD. Population projections for Taiwan area 2006-2051 report. Council for Economic Planning and Development, Executive Yuan, Republic of China (Taiwan). 2005.
 NDC. Population Projections for R.O.C. (Taiwan): 2016∼2060. Depart-ment of Human Resources Development National Development Council. 2016.
 Orebaugh SL. Difficult airway management in the emergency depart-ment. Journal of Emergency Medicine. 2002; 22: 31-48.
 Orozco-Diaz E, Alvarez-Rios JJ, Arceo-Diaz JL, Ornelas-Aguirre JM. Predictive factors of difficult airway with known assessment scales. Cirugia y Cirujanos. 2010; 78: 393-399.
 El-Orbany M, Woehlck HJ. Difficult mask ventilation. Anesthesia and Analgesia. 2009; 109: 1870-1880.
 Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the american society of anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013; 118: 251-270.
 Krage R, van Rijn C, van Groeningen D, Loer SA, Schwarte LA, Schober P. Cormack-Lehane classification revisited. British Journal of Anaesthesia. 2010; 105: 220-227.
 Meiring PD, Blake AJ, Grobbelaar JP. Identification and definition of the geriatric patient in a teaching hospital. South African Medical Journal. 1983; 64: 670-673.
 Gaszyńska E, Gaszyński T. The influence of different airway manage-ment strategies on chest compression fraction in simulated cardiopul-monary resuscitation, provided by paramedics: LMA Supreme versus Endotracheal Intubation and Combitube. Signa Vitae. 2014; 9: 22-26.
 Cierniak M, Nowakowski M, Timler DR. A comparison of the effectiveness of intubation using a McGrath Series 5 videolaryngoscope with either a Truflex articulating stylet or a standard intubation stylet in a group of medical students. Signa Vitae. 2015; 10: 127-135.
 Kitamura M, Dohgomori H, Okamoto K. Difficult airway management in the emergency room using an airway scope. Signa Vitae. 2008; 3: 55-56.
 Wass TC, Jacob AK, Kopp SL, Torsher LC. A prospective randomized high fidelity simulation center based side-by-side comparison analyzing the success and ease of conventional versus new generation video laryngoscope technology by inexperienced laryngoscopists. Signa Vitae. 2011; 6: 36-45.
 Takemura M, Matsuura Y, Fujisaki E, Takenaka M, Sato J. Comparison of difficulty in airway intubation with aging. Study on 71 subjects who had an airway intubation 20-or-more years earlier. Japanese Journal of Anesthesiology. 2014; 63: 1314-1318.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.