Table 3 Final airway management variables

Number

Data variable name

Type of data

Data variable categories or values

Choose only one option unless otherwise stated.

Definition of data variable

19

Use of checklist for airway management

Ordinal

1 = Written checklist available and used on scene

2 = Written checklist available, but not used

3 = No checklist available

Written checklist for airway management including rapid sequence induction (RSI) available in service and used on-scene (challenge and response system).

20

Oxygenation strategy for airway management

Ordinal

1 = Preoxygenation with non rebreathable face mask before airway attempt

2 = Preoxygenation with Bag-valve-mask (BVM) before airway attempt

3 = Apnoeic oxygenation during airway attempt

4 = No preoxygenation

Oxygenation strategies used before or during advanced airway management.

Select all that apply.

21

Sequence of providers performing airway management

Nominal

☐☐ Emergency Medical Technician

☐☐ Paramedic

☐☐ Nurse (non-anaesthesia)

☐☐ Nurse (anaesthesia)

☐☐ Physician (General practitioner or other non-EP/ICU/Anaesthesiologist)

☐☐ Physician (Emergency Physician - EP)

☐☐ Physician (Intensivist - ICU)

☐☐ Physician (Anaesthesiologist)

☐☐ Unknown

Specify level of EMS provider in sequence, who performed each airway management attempt, numbered in order of attempt.

Select all that apply.

Specify number of attempt alongside corresponding provider with “1” and if more attempts “2”, “3”,“4”.

E.g.: If paramedic fails first attempt, then physician has two attempts, this is recorded as:

“1” Paramedic.

“2–3” Physician.

Select all that apply.

22

Sequence of airway devices used for airway management

Nominal

☐☐ Bag-valve-mask ventilation (BVM)

☐☐ Supraglottic airway device with suction

☐☐ Supraglottic airway device without suction

☐☐ Direct laryngoscopy with endotracheal tube

☐☐ Direct laryngoscopy with endotracheal tube and stylet

☐☐ Direct laryngoscopy with bougie and endotracheal tube

☐☐ Video laryngoscopy (Macintosh or Miller like blade) with endotracheal tube

☐☐ Video laryngoscopy (Macintosh or Miller like blade) with endotracheal tube and stylet

☐☐ Video laryngoscopy (Macintosh or Miller like blade) with bougie and endotracheal tube

☐☐ Video laryngoscopy (hyperangulated blade) with endotracheal tube

☐☐ Video laryngoscopy (hyperangulated blade) with endotracheal tube and stylet

☐☐ Video laryngoscopy (hyperangulated blade) with bougie and endotracheal tube

☐☐ Surgical emergency airway equipment

☐☐ Percutaneous emergency airway equipment

☐☐ Jet-ventilation equipment

☐☐ Other, describe: _______________

☐☐ Unknown

Specify first attempt with “1” and if more attempts “2”, “3”,“4”.

E.g.: If first attempt fails with endotracheal intubation and direct laryngoscopy, and the next two attempts are endotracheal intubation with video laryngoscopy, this is recorded as:

“1” Direct laryngoscopy with endotracheal tube

“2–3” Video laryngoscopy (Macintosh or Miller like blade) with endotracheal tube

BVM = Bag-valve-mask ventilation, includes insertion of oro/nasopharyngeal airway.

If bag-valve-mask ventilation prior to RSI, choose “BVM” as “1”.

Video laryngoscopy (VL) differentiates between:

VL with Macintosh/miller like blade

VL with hyperangulated blade

Select all that apply.

23

Airway management results

Ordinal

1 = Successful airway management with ET as planned

2 = Successful airway management with SAD as planned

3 = Successful airway management with surgical airway as planned

4 = Failure of primary airway plan, and airways secured by alternative technique

5 = Final airway management failed (loss of airways)

6 = Unknown

ET = Endotracheal tube

SAD = Supraglottic airway device

24

Airway manoeuvres following failed airway attempt.

Nominal

1 = Cricoid pressure released

2 = BURP/ELM manoeuvres

3 = Release MILS

4 = Reposition patient

5 = Ramping patient

6 = None / Not applicable.

Airway manoeuvres following unsuccessful airway management attempts.

BURP = Backwards upwards rightwards pressure.

ELM = External laryngeal manipulation

MILS = Manual In-line stabilisation

Ramping = The head and trunk are elevated or supported to align the external auditory meatus with the sternal notch in the horizontal plane

Select all that apply.

25

Drugs used to facilitate airway management

Nominal

1 = None

2 = Thiopental

3 = Ketamine

4 = S-ketamine

5 = Propofol

6 = Fentanyl

7 = Alfentanil

8 = Morphine

9 = Midazolam

10 = Diazepam

11 = Suxamethonium

12 = Rocuronium

13 = Vasopressor

14 = Lidocain

15 = Etomidate

16 = Other, describe: ________________

Drugs used to facilitate the actual airway intervention, not including sedation in the post-intervention or transport phase.

Vasopressor includes any drug used as vasopressor during airway management, e.g. phenylephrine.

Local anaesthetic includes any drug used as local or regional anaesthetic, e.g. lidocaine.

Select all that apply.

26

Complications during airway management

Nominal

1 = ET misplaced in oesophagus AND recognised/corrected immediately

2 = ET misplaced in oesophagus and NOT recognised/corrected immediately

3 = ET misplaced in left or right main stem bronchus

4 = Incorrect positioning or difficult ventilation with SAD

5 = Dental trauma

6 = Aspiration or vomiting during airway management (and NOT present before)

7 = Cardiac arrest during airway management

8 = Hypoxia during airway management

9 = Bradycardia during airway management

10 = Hypotension during airway management

11 = Complications during surgical or percutaneous airway (e.g. bleeding or pneumothorax)

12 = No complications (confirmed) during airway management

13 = Insufficient data recording, complications unsure.

Complications recognised during airway management or device verification (and NOT present before the airway management).

Select all that apply.

ET = Endotracheal tube, SAD = Supraglottic airway device

The following definitions are used:Hypoxia: Adults and children: SpO2 < 90%

Hypotension:

infants < 1 year: SBP < 70 mmHg

children 1 to 10 years: SBP < 70 + (2 × age)

children > 10 years: SBP < 90 mmHg

adults: SBP < 90 mmHg or decrease > 10% from baseline value

Bradycardia

newborn to 3 years: <  100 bpm

3 to 9 years: <  80 bpm

10 to 16 years: <  60 bpm

adults: <  50 bpm

Select all that apply.

27

Total number of successful endotracheal intubations the provider has performed in patients

Ordinal

0 = < 10

1 = 11–25

2 = 26–50

3 = 51–100

4 = 101–250

5 = 251–1000

6 = 1001–2500

7 = > 2500

Total number of successful endotracheal intubations the provider has performed in patients in hospital and pre-hospital service, not including mannequin intubations or SAD.

28

Blood pressure, after finalised airway management

Continuous and Nominal

1 = Number, describe (Syst-BP/Dias-BP (MAP))

2 = NA: Did not measure

3 = NA: Could not measure

Value recorded within 1–3 min after finalised airway management

29

SpO₂, after finalised airway management

Continuous and Nominal

1 = Number, describe

2 = NA: Did not measure

3 = NA: Could not measure

Value recorded within 1–3 min after finalised airway management

30

EtCO₂, after finalised airway management

Continuous and Nominal

1 = Number, describe

2 = NA: Did not measure

3 = NA: Could not measure

Value recorded within 1–3 min after finalised airway management

31

Ventilation, after finalised airway management

Nominal

1 = Spontaneous ventilation

2 = Controlled manual ventilation

3 = Controlled mechanical ventilation (ventilator)

4 = Mixed ventilation

5 = Unknown

Main mode of ventilation on-scene and during transport of patient following finalised airway management.

If both spontaneous and controlled ventilation, choose “mixed ventilation”

32

Survival to hospital

Nominal

1 = Dead on-scene after ALS interventions

2 = Alive on hospital arrival (including patients being transported with on-going mechanical chest compressions or ECPR)

3 = Unknown

Patient survival status limited to pre-hospital treatment and arrival at hospital (Short term survival)

ALS = Advanced Life Support

ECPR = extracorporeal cardiopulmonary resuscitation