102 Development of an Awake Tracheal Intubation Pack: promoting safe practice of essential airway skills

Published Date: 01st September 2024

Publication Authors: Harwood. S, Ashe. M, Jain. N, Chitgopkar. S

Background
Awake tracheal intubation (ATI) is the gold standard in predicted difficult airway management, however, despite this it is used for only 0.2% of intubations in the UK. After organising multidisciplinary ATI training in a district general hospital where ATI is infrequently performed, we identified a local need for simplification of the process to remove potential barriers to performing ATI when indicated and reduce cognitive load during this less routine, potentially stressful situation. We designed an 'ATI pack' containing checklist, patient information leaflet and documentation sticker for the anaesthetic record. (Figure presented.) Methods: Anaesthetic trainees and consultants were surveyed about experiences and confidence with ATI, before and after training. We developed a checklist based on Difficult Airway Society guidelines incorporating local protocols, a patient information leaflet to guide consent and sticker to standardise documentation. These were reviewed by consultants within our department and at the regional 'Airway Leads' meeting and adjusted according to feedback.

Result(s)
After training, confidence to undertake all aspects of ATI (identifying patients, consent, preparation, bronchoscopy and sedation) improved. However, 91% (20/22) of respondents stated a checklist would help when performing ATI. The 'ATI pack' received high praise locally and regionally from colleagues although requires formal review of effectiveness once used by a larger sample of our anaesthetic team.

Discussion(s)
In high risk situations where infrequently used technical skills are required, reducing additional cognitive load improves focus on task performance. In our hospital ATI is performed less than 10 times annually. The pack was created to reduce barriers to performing ATI and provide guidance, simplifying the process, allowing clinicians' clearer focus on technical aspects. Clear evidence demonstrates that checklists improve quality of medical care, and although checklist fatigue can be an issue we believe less familiar, potentially stressful situations like this are when they prove most effective.

Result(s)
The CLBI had significantly lower SR at both 1st and 3rd attempt (31% and 64%, respectively) as compared to DL (93% and 98%), Glidescope (70% and 86%) and McGrath (58% and 84%), with all p < 0.001. Moreover, CLBI had significantly longer cTTI (158.5 seconds; (54.3; 180)) than other devices: Glidescope (37.6 seconds; (24.7; 88.2)), McGrath (39.3 seconds; (20.6; 105.1)), and DL (19 seconds; (15.4; 27.2)), all p < 0.002. CLBI and McGrath were the only approaches performing better in senior as compared to junior residents.

Conclusions
In a DAM simulated setting, anesthesiology residents had lower SR and longer cTTI with the CLBI as compared to direct and video-laryngoscopy.

Harwood; S; Ashe, S; Jain,N; Chitgopkar, S. (2024). Development of an Awake Tracheal Intubation Pack: promoting safe practice of essential airway skills. Trends in Anaesthesia and Critical Care. 57(Suppl 1), pp.18-19. [Online]. Available at: https://dx.doi.org/10.1016/j.tacc.2024.101412 [Accessed 8 January 2026].