Global airway management of the unstable cervical spine survey (GAUSS)

Abstract

Background: Rapid advancement in optical and video devices used for indirect visualisation of the airway has expanded the options for emergency and elective endotracheal intubation in patients with unstable fractures of the cervical spine. Aiming to ascertain whether videolaryngoscopy (VL) has replaced awake flexible intubation (AFI) as the preferred technique for airway management, we conducted a global survey to evaluate current clinical practice.
Methods: After obtaining ethics approval, we created a questionnaire featuring two hypothetical patients with unstable injuries of the cervical spine – one emergency and one urgent elective. Target sample sizes per country were estimated using data from the World Federation of Societies of Anaesthesiologists’ (WFSA) Global Anaesthesia Workforce Survey. Respondents were asked about their training, experience, airway skills, current clinical setting and availability of airway equipment, as well as their preferred airway strategy in each case. The questionnaire was actively distributed for one year through the WFSA member societies and through social networks to physician anaesthesia providers (PAPs). Global and regional trends were assessed using descriptive statistics.
Results: Of a total of 1 904 responses, 1 153 (101 countries) were included in the final analysis. In the emergency case, 46.9% (95% confidence interval [CI] 44.0–49.8%) of respondents preferred VL and 39.8% (95% CI 38.0–42.6%) chose AFI. In the urgent elective case, 51.3% (95% CI 48.3–54.3%) selected VL as their preferred method, while 37.3% (95% CI 34.4–40.2%) indicated AFI. Significant regional variations in preference were found.
Conclusion: The results suggest that practice in airway management of unstable cervical spine fractures is changing. Currently PAPs tend to favour VL over AFI. There is a statistically significant preference for VL in elective cases which is traditionally considered to be a stronghold of AFI.