It is a great pleasure to become President of the Society for Airway Management (SAM) this year as our annual meeting was held in Atlanta Georgia. It was 21 years ago, as one of the founding members, I attended the first meeting in Atlanta to form the Chapter for SAM with Dr. Andy Ovassapian. To commemorate this we had an outstanding 19th Annual meeting chaired by Dr. Felipe Urdaneta. SAM’s goals and involvement in airway management for the 21st century is a global initiative to increase patient safety through technology, training and collaboration. In order to discuss this, it is important to discuss the past and present as well. Airway equipment and technology has proliferated over the past 20 years.
In the first years of our annual meeting our airway workshops consisted of maybe 10 stations such as the adult FOB, pediatric FOB and classic LMA. Now we have 11 rooms with 4-5 stations in each room. Equipment has come and gone. The COPA, combitube or even my Foley Airway Stylet used to intubate through the Intubating LMA are no longer available. The original indirect laryngoscope, Bullard or Wu Scope, have been replaced with the video laryngoscopes or light wand, a blind technique replaced by the optical rigid stylets. In the 21st century we will be seeing Ultra Sound as a new tool for airway management. We have been teaching identification of the cricothyroid membrane at our airway workshops by Dr. Michael Kristian who has published many papers on this. But ultrasound is further being used to hel p predict a difficult intubation, identify pathology of the airway prior to intubation, and placement of ETT and ventilation of the lungs after intubation by the bedside. Dr. Scott Segal presented this meeting new technology of accurate classification of a difficult intubation by a computerized facial analysis. And hopefully next year we will be seeing the OSU scope, a robotic type system for intubation. Will the video laryngoscope replace direct laryngoscopy? Or as video laryngoscopy becomes the first line of intubation, will the direct laryngoscopy become the rescue device and be placed on the difficult airway cart? And are we going to see decrease use of the fiberoptic broncoscope as residents are being trained less and less in its use? What is the new gold standard?
There are multiple DifficultAirway Guidelinessuch as ASA, DAS, and Canadian Airway Task Force to name a few of all which have limitations due to lack of validation in clinical trials. Even with all this new great technology with airway management over the past 10-20 years, we are still having problems with bad outcomes and patient safety in airway management. As the NAP4, AIMS, and ASA closed claims has shown is there are two areas that need to be improved in the 21st Century. First, isthe technical aspect of knowing how to use the equipment and having the equipment available. Second in the non-technical aspect or HUMAN FACTORS such as the clinical judgement, situational awareness, communication and team work. This is reiterated by the NAP4 which showed that even when a difficult intubation was anticipated the anesthesiologist proceeded with the induction of general anesthesia in 81% of the cases.
The challenges of training which has been a controversy for years is “Practicing” on patie nts for elective surgery. Is the risk greater than the benefit? My feeling is that the benefit of practicing and maintaining skills of airway equipment is greater for when a difficult airway is encounter it will not be the first or second time you have used the equipment. Airway training varies amongst different institutions due to availability of equipment as well as the staff teaching it. There is NO STANDARDIZATION. An example is a recent survey was done in the UK that showed only 6% had video laryngoscopes and of those some were locked up for emergencies. And lastly, one cannot teach one who does not want to learn. As SAM was being formed, I had colleagues say why do we need a society for airway management, aren’t we all trained how to intubate. If that was the case, we would not have the outcomes we have in the ASA closed claims and NAP4. Mannequins are used to teach the technical training and increase the slope of the learning curve. As we go into the 21st century the mannequins are becoming closerin simulation of humans. But they do not help teach the non-technical human factors. Airway simulation centers at this time are being conducted to help teach human but factors they are expensive to run, limited access, with no standardization or bench marks. Advanced Airway Management Fellowships are being offered.
Presently Dr. Tracey Straker out of MortifierHospital in New York, and Dr. Richard Cooper out of Toronto to name a couple are offering a year fellowship. It is the charge of the SAM Trainee committee to gather information on each advanced airway management fellowship in order for it to be placed on the SAM Website. So please contact Dr. Tracey Straker if you offer an airway fellowship. Collaboration now and in the future is very importantfor improving patient safety in airway management. As reported in the ASA closed claims and NAP4, the increase in airway problems that lead to morbidity and mortality outside the operating room were due to lack of available equipment, experienced personal, recognition of a difficult airway. One of the first reports of a collaborative team on airway management outside the OR was by Dr Lynette Mark and Lauren Berkow with the Dart Program at Johns Hopkin. They addressed these problems by setting up Difficult Airway Carts at strategic locations throughout the hospital, an emergency team made up of anesthesia, ENT and other support staff to manage the airway. We are now seeing the Safer Airway Module that provides an integrated set of validated best practices and resources for a comprehensive and coordinated approach for intubation in the hospital regardless of size and location. We are also seeing further International collaboration amongst different airway societies. Last year in 2015, SAM and DAS who were formed in parallel 21 years ago, had its first World Airway Management Meeting (WAMM) in Dublin Ireland. There were over 1800 attendees from 58 countries spanning 6 continents. What a NATO of airway fanatics all in one place.
This year with the special projects committee and international liaison committee, SAM has voted in new bylaws for International chapters. These can be found on the SAM website. But now we have at least 8 international chapters who will be contributing to SAM. The Society for Airway Management is as good as its members. So this year we have initiated self nomination and colleague nominations for the different SAM committees. We will continue to do this each year, with applications being accepted from April to June. An email will be sent out as a reminder and the application will be able to be found on line. As a SAM committee member, it is encouraged that they attend the annual meeting as this is an important time when all committee members meet in person to brainstorm ideas. From there you will be having email or teleconferences. As our mission states we are a multi-disciplinary group of caregivers that are interest in airway management.
Over my next 2 years I would like to see SAM continue to grow with new technology and research, greater collaboration, and advanced airway training amongst the different specialties.
Lorraine J. Foley, MD, MBA President, Society for Airway Management