Article Data

  • Views 1615
  • Dowloads 182

Reviews

Open Access

Emergency airway management with the gum elastic bougie outside of the operating room: a narrative review

  • Yuko Ono1,2,*,
  • Kazuaki Shinohara2
  • Jiro Shimada3
  • Shigeaki Inoue1
  • Joji Kotani1

1Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 650-0017 Kobe, Japan

2Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 963-8558 Koriyama, Japan

3Futaba Medical Center, Fukushima Medical University, 960-1295 Fukushima, Japan

DOI: 10.22514/sv.2023.074 Vol.19,Issue 5,September 2023 pp.29-37

Submitted: 28 November 2022 Accepted: 24 February 2023

Published: 08 September 2023

*Corresponding Author(s): Yuko Ono E-mail: windmill@people.kobe-u.ac.jp

Abstract

The ongoing coronavirus 2019 (COVID-19) pandemic has increased the need for healthcare professionals to perform emergency endotracheal intubation (ETI) in patients with COVID-19-related respiratory failure outside of the operating room. Difficult airways and severe airway-related adverse events occur much more frequently in such settings due to limited time and resources as well as the patient’s reduced physiological reserve. The gum elastic bougie (GEB) intubation tube is an inexpensive, simple, and readily transportable aid to intubation, but its effectiveness in emergency airway management has not been comprehensively evaluated in recent years. Here, we performed a literature review and have updated the available evidence on the utility of GEB in emergency airway management. After a systematic MEDLINE search, we identified 36 relevant reports that compared GEB with alternative airway management approaches in a variety of real-world and simulated settings. In most studies, GEB increased the first-pass ETI success rate and decreased the force applied on the tongue and incisors during laryngoscopy. GEB also increased the speed, safety, and reliability of emergency cricothyrotomy. Conflicting results were obtained in studies examining GEB use for ETI during cardiopulmonary resuscitation, and other special circumstances such as selective lung ventilation, the presence of vomitus, and the use of personal protective equipment. These results suggest that GEB use could be expanded beyond difficult airways and rescue after failed ETI attempts, but further studies will be necessary to determine the utility of GEB under special conditions. Because fatal airway-related adverse events can in part be attributed to limited accessibility of proper airway management equipment, devices such as GEB may increase successful outcomes, especially under the overwhelmingly challenging conditions imposed by the COVID-19 pandemic.


Keywords

Gum elastic bougie; Safety redundancy; Airway-related adverse events; Difficult airway management


Cite and Share

Yuko Ono,Kazuaki Shinohara,Jiro Shimada,Shigeaki Inoue,Joji Kotani. Emergency airway management with the gum elastic bougie outside of the operating room: a narrative review. Signa Vitae. 2023. 19(5);29-37.

References

[1] Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Critical Care Medicine. 2006; 34: 2355–2361.

[2] Heuer JF, Barwing TA, Barwing J, Russo SG, Bleckmann E, Quintel M, et al. Incidence of difficult intubation in intensive care patients: analysis of contributing factors. Anaesthesia and Intensive Care. 2012; 40: 120–127.

[3] Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011; 114: 42–48.

[4] De Jong A, Molinari N, Pouzeratte Y, Verzilli D, Chanques G, Jung B, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. British Journal of Anaesthesia. 2015; 114: 297–306.

[5] De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. American Journal of Respiratory and Critical Care Medicine. 2013; 187: 832–839.

[6] Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesthesia & Analgesia. 2004; 82: 607–613.

[7] Hasegawa K, Shigemitsu K, Hagiwara Y, Chiba T, Watase H, Brown CA 3rd, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Annals of Emergency Medicine. 2012; 60: 749–754.e2.

[8] Reed MJ. Can an airway assessment score predict difficulty at intubation in the emergency department? Emergency Medicine Journal. 2005; 22: 99–102.

[9] Walls RM, Brown CA, Bair AE, Pallin DJ. Emergency airway management: a multi-center report of 8937 emergency department intubations. The Journal of Emergency Medicine. 2011; 41: 347–354.

[10] Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations. Annals of Emergency Medicine. 2015; 65: 363–370.e1.

[11] Combes X, Jabre P, Margenet A, Merle JC, Leroux B, Dru M, et al. Unanticipated difficult airway management in the prehospital emergency setting. Anesthesiology. 2011; 114: 105–110.

[12] Timmermann A, Eich C, Russo SG, Natge U, Bräuer A, Rosenblatt WH, et al. Prehospital airway management: a prospective evaluation of anaesthesia trained emergency physicians. Resuscitation. 2006; 70: 179–185.

[13] Breckwoldt J, Klemstein S, Brunne B, Schnitzer L, Arntz H, Mochmann H. Expertise in prehospital endotracheal intubation by emergency medicine physicians—comparing ‘proficient performers’ and ‘experts’. Resuscitation. 2012; 83: 434–439.

[14] Adnet F, Borron S, Racine S, Clemessy J, Fournier J, Plaisance P, et al. The intubation difficulty scale (IDS) anesthesiology. 1997; 87: 1290–1297.

[15] Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. 2015; 70: 272–281.

[16] Burkle CM, Walsh MT, Harrison BA, Curry TB, Rose SH. Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital. Canadian Journal of Anesthesia. 2005; 52: 634–640.

[17] Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, et al. The unanticipated difficult airway with recommendations for management. Canadian Journal of Anaesthesia. 1998; 45: 757–776.

[18] Langeron O, Cuvillon P, Ibanez-Esteve C, Lenfant F, Riou B, Le Manach Y. Prediction of difficult tracheal intubation. Anesthesiology. 2012; 117: 1223–1233.

[19] Lundstrøm L, Møller A, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation. Anesthesiology. 2009; 110: 266–274.

[20] Peterson G, Domino K, Caplan R, Posner K, Lee L, Cheney F. Management of the difficult airway. Anesthesiology. 2005; 103: 33–39.

[21] Cook TM, Woodall N, Frerk C; 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 1: anaesthesia. British Journal of Anaesthesia. 2011; 106: 617–631.

[22] Cook TM, Woodall N, Harper J, Benger J. 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.

[23] Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the difficult airway society, the association of anaesthetists the intensive care society, the faculty of intensive care medicine and the royal college of anaesthetists. Anaesthesia. 2020; 75: 785–799.

[24] Thomas AN, McGrath BA. Patient safety incidents associated with airway devices in critical care: a review of reports to the UK national patient safety agency. Anaesthesia. 2009; 64: 358–365.

[25] Cook TM, MacDougall-Davis SR. Complications and failure of airway management. British Journal of Anaesthesia. 2012; 109: i68–i85.

[26] Macintosh RR. An aid to oral intubation. The British Medical Journal. 1949; 1: 28.

[27] Latimer AJ, Harrington B, Counts CR, Ruark K, Maynard C, Watase T, et al. Routine use of a bougie improves first-attempt intubation success in the out-of-hospital setting. Annals of Emergency Medicine. 2021; 77: 296–304.

[28] Ångerman S, Kirves H, Nurmi J. A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation. Anaesthesia. 2018; 73: 348–355.

[29] Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018; 319: 2179–2189.

[30] Driver B, Dodd K, Klein LR, Buckley R, Robinson A, McGill JW, et al. The bougie and first-pass success in the emergency department. Annals of Emergency Medicine. 2017; 70: 473–478.e1.

[31] Driver BE, Semler MW, Self WH, Ginde AA, Trent SA, Gandotra S, et al. Effect of use of a bougie vs. endotracheal tube with stylet on successful intubation on the first attempt among critically ill patients undergoing tracheal intubation: a randomized clinical trial. JAMA. 2021; 326: 2488–2497.

[32] Ono Y, Shinohara K, Shimada J, Inoue S, Kotani J. Lower maximum forces on oral structures when using gum-elastic bougie than when using endotracheal tube and stylet during both direct and indirect laryngoscopy by novices: a crossover study using a high-fidelity simulator. BMC Emergency Medicine. 2020; 20: 34.

[33] Brazil V, Grobler C, Greenslade J, Burke J. Comparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques. Emergency Medicine Australasia. 2012; 24: 194–200.

[34] Kovacs G, Law JA, McCrossin C, Vu M, Leblanc D, Gao J. A comparison of a fiberoptic stylet and a bougie as adjuncts to direct laryngoscopy in a manikin-simulated difficult airway. Annals of Emergency Medicine. 2007; 50: 676–685.

[35] Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehospital Emergency Care. 2011; 15: 30–33.

[36] Phelan MP, Moscati R, D’Aprix T, Miller G. Paramedic use of the endotracheal tube introducer in a difficult airway model. Prehospital Emergency Care. 2003; 7: 244–246.

[37] Nielsen AA, Hope CB, Bair AE. GlideScope videolaryngoscopy in the simulated difficult airway: bougie vs. standard stylet. The Western Journal of Emergency Medicine. 2010; 11: 426–431.

[38] Michalek P, Donaldson W, Graham C, Hinds JD. A comparison of the I- gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: a manikin study. Resuscitation. 2010; 81: 74–77.

[39] Brown CA 3rd, Kaji AH, Fantegrossi A, Carlson JN, April MD, Kilgo RW, et al. Video laryngoscopy compared to augmented direct laryngoscopy in adult emergency department tracheal intubations: a national emergency airway registry (NEAR) study. Academic Emergency Medicine. 2020; 27: 100–108.

[40] Kaji AH, Shover C, Lee J, Yee L, Pallin DJ, April MD, et al. Video versus direct and augmented direct laryngoscopy in pediatric tracheal intubations. Academic Emergency Medicine. 2020; 27: 394–402.

[41] Komasawa N, Cho T, Mihara R, Minami T. Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial. The American Journal of Emergency Medicine. 2016; 34: 54–56.

[42] Cho T, Komasawa N, Hattori K, Mihara R, Minami T. Gum-elastic bougie efficacy for tracheal intubation during continuous chest compression in infants—a crossover simulation trial. The Journal of Emergency Medicine. 2016; 51: 19–24.

[43] Halhalli HC, Özbek AE, Çelİk E, Yİğİt Y, Yilmaz S, Çardak M. Benefits of using an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope for endotracheal intubation performed by inexperienced doctors during mechanical CPR: a randomized prospective crossover study. World Journal of Emergency Medicine. 2019; 10: 182.

[44] Ozbek AE, Halhalli HC, Yilmaz S, Celik E, Ozerol H, Şancı E. Effects of using an endotracheal tube introducer for intubation during mechanical chest compressions of a manikin: randomized, prospective, crossover study. The Journal of Emergency Medicine. 2020; 59: 56–60.

[45] Tandon N, McCarthy M, Forehand B, Carlson JN. Comparison of intubation modalities in a simulated cardiac arrest with uninterrupted chest compressions. Emergency Medicine Journal. 2014; 31: 799–802.

[46] Karaca O, Bayram B, Oray NC, Acerer A, Sofuoglu Z. Comparison of the airway access skills of prehospital staff in moving and stationary ambulance simulation: a randomized crossover study. Turkish Journal of Emergency Medicine. 2017; 17: 35–41.

[47] Bonnette AJ, Aufderheide TP, Jarvis JL, Lesnick JA, Nichol G, Carlson JN, et al. Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial. Resuscitation. 2021; 158: 215–219.

[48] Hill C, Reardon R, Joing S, Falvey D, Miner J. Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab. Academic Emergency Medicine. 2010; 17: 666–669.

[49] Driver BE, Klein LR, Perlmutter MC, Reardon RF. Emergency cricothy-rotomy in morbid obesity: comparing the bougie-guided and traditional techniques in a live animal model. The American Journal of Emergency Medicine. 2021; 50: 582–586.

[50] Chrisman L, King W, Wimble K, Cartwright S, Mohammed KB, Patel B. Surgicric 2: a comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model. British Journal of Anaesthesia. 2016; 117: 236–242.

[51] Yeow C, Greaney L, Foy C, King W, Patel B. Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy. Anaesthesia. 2018; 73: 1235–1243.

[52] Quick JA, MacIntyre AD, Barnes SL. Emergent surgical airway: comparison of the three-step method and conventional cricothyroidotomy utilizing high-fidelity simulation. The Journal of Emergency Medicine. 2014; 46: 304–307.

[53] Chang SS, Tong QJ, Beh ZY, Quek KH, Ang BH. A bench study comparing between scalpel-bougie technique and cannula-to-Melker technique in emergency cricothyroidotomy in a porcine model. Korean Journal of Anesthesiology. 2018; 71: 289–295.

[54] Rees KA, O’Halloran LJ, Wawryk JB, Gotmaker R, Cameron EK, Woonton HDJ. Time to oxygenation for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model. Anaesthesia. 2019; 74: 1153–1157.

[55] Heard A, Gordon H, Douglas S, Grainger N, Avis H, Vlaskovsky P, et al. Front-of-neck airway rescue with impalpable anatomy during a simulated cannot intubate, cannot oxygenate scenario: scalpel-finger-cannula versus scalpel-finger-bougie in a sheep model. British Journal of Anaesthesia. 2020; 125: 184–191.

[56] Nakstad AR, Bredmose PP, Sandberg M. Comparison of a percuta-neous device and the bougie-assisted surgical technique for emergency cricothyrotomy: an experimental study on a porcine model performed by air ambulance anaesthesiologists. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 21: 59.

[57] Umek N, Hodzovic I, Damjanovska M, Cvetko E, Zel J, Seliskar A, et al. Rescue oxygenation success by cannula or scalpel-bougie emergency front-of-neck access in an anaesthetised porcine model. PLoS One. 2020; 15: e0232510.

[58] Milk N, Rosman Y, Yavnai N, Cohen B, Ophir N, Eisenkraft A, et al. Intubation using the gum-elastic bougie while wearing personal protective equipment. American Journal of Disaster Medicine. 2020; 15: 85–92.

[59] Komasawa N, Hyoda A, Matsunami S, Majima N, Minami T. Utility of a gum-elastic bougie for difficult airway management in infants: a simulation-based crossover analysis. BioMed Research International. 2015; 2015: 1–5.

[60] Matsunami S, Komasawa N, Majima N, Ueno T, Minami T. Evaluation of gum-elastic bougie with direct and indirect laryngoscope for infant difficult airway management: a Pierre Robin simulation model. Journal of Clinical Anesthesia. 2016; 30: 59–60.

[61] Halhallı H, Ozerol H, Şancı E, Karakayalı O, Aydın E. Selective intubation with endotracheal tube introducer in difficult airway: a randomized, prospective, cross-over study. Turkish Journal of Emergency Medicine. 2021; 21: 205.

[62] Ohchi F, Komasawa N, Mihara R, Hattori K, Minami T. Evaluation of gum-elastic bougie combined with direct and indirect laryngoscopes in vomitus setting: a randomized simulation trial. The American Journal of Emergency Medicine. 2017; 35: 584–588.

[63] Centre for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine: Levels of Evidence. 2009. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009 (Accessed: 22 March 2023).

[64] Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review. 2019; 4: 5.

[65] Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018; 169: 467–473.

[66] Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7: e35797.

[67] Dashti M, Amini S, Azarfarin R, Totonchi Z, Hatami M. Hemodynamic changes following endotracheal intubation with glidescope(®) video-laryngoscope in patients with untreated hypertension. Research in Cardiovascular Medicine. 2014; 3: e17598.

[68] Warner M, Benenfeld S, Warner M, Schroeder D, Maxson P. Perianes-thetic dental injuries. Anesthesiology. 1999; 90: 1302–1305.

[69] Kim C, Kang HG, Lim TH, Choi BY, Shin Y, Choi HJ. What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments? Emergency Medicine Journal. 2013; 30: 888–892.

[70] Goto Y, Goto T, Hagiwara Y, Tsugawa Y, Watase H, Okamoto H, et al. Techniques and outcomes of emergency airway management in Japan: an analysis of two multicentre prospective observational studies, 2010–2016. Resuscitation. 2017; 114: 14–20.

[71] Takeuchi S, Shiga T, Koyama Y, Nakanishi T, Honma Y, Morita H, et al. Longitudinal acquisition of endotracheal intubation skills in novice physicians. PLoS One. 2017; 12: e0188224.

[72] Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, et al. Unanticipated difficult airway in anesthetized patients. Anesthesiology. 2004; 100: 1146–1150.

[73] Takenaka I, Aoyama K, Iwagaki T, Ishimura H, Takenaka Y, Kadoya T. Approach combining the airway scope and the bougie for minimizing movement of the cervical spine during endotracheal intubation. Anesthesiology. 2009; 110: 1335–1340.

[74] Berkow LC, Greenberg RS, Kan KH, Colantuoni E, Mark LJ, Flint PW, et al. Need for emergency surgical airway reduced by a comprehensive difficult airway program. Anesthesia & Analgesia. 2009; 109: 1860–1869.

[75] Ono Y, Yokoyama H, Matsumoto A, Kumada Y, Shinohara K, Tase C. Surgical airways for trauma patients in an emergency surgical setting: 11 years’ experience at a teaching hospital in Japan. Journal of Anesthesia. 2013; 27: 832–837.

[76] Sagarin MJ, Barton ED, Chng Y, Walls RM. Airway management by us and canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Annals of Emergency Medicine. 2005; 46: 328–336.

[77] Levitan RM, Rosenblatt B, Meiner EM, Reilly PM, Hollander JE. Alternating day emergency medicine and anesthesia resident responsibility for management of the trauma airway. Annals of Emergency Medicine. 2004; 43: 48–53.

[78] Stephens CT, Kahntroff S, Dutton RP. The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center. Anesthesia & Analgesia. 2009; 109: 866–872.

[79] Cobas MA, De la Peña MA, Manning R, Candiotti K, Varon AJ. Prehospital intubations and mortality: a level 1 trauma center perspective. Anesthesia & Analgesia. 2009; 109: 489–493.

[80] Foley LJ, Urdaneta F, Berkow L, Aziz MF, Baker PA, Jagannathan N, et al. Difficult airway management in adult coronavirus disease 2019 patients: statement by the society of airway management. Anesthesia & Analgesia. 2021; 133: 876–890.

[81] Hendler I, Nahtomi O, Segal E, Perel A, Wiener M, Meyerovitch J. The effect of full protective gear on intubation performance by hospital medical personnel. Military Medicine. 2000; 165: 272–274.

[82] Castle N, Owen R, Hann M, Clark S, Reeves D, Gurney I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low- and high-dexterity airway and vascular access skills. Resuscitation. 2009; 80: 1290–1295.

[83] Ong MS, Coiera E. Safety through redundancy: a case study of in-hospital patient transfers. BMJ Quality & Safety. 2010; 19: e32–e32.

[84] Levitan RM. Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving. Annals of Emergency Medicine. 2003; 42: 81–87.

[85] Ono Y, Shinohara K, Goto A, Yano T, Sato L, Miyazaki H, et al. Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan. Journal of Anesthesia. 2016; 30: 205–214.

[86] Rognås LK, Hansen T. EMS-physicians’ self reported airway management training and expertise; a descriptive study from the central region of Denmark. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2011; 19: 10.

[87] Schmid M, Mang H, Ey K, Schüttler J. Prehospital airway management on rescue helicopters in the United Kingdom. Anaesthesia. 2009; 64: 625–631.

[88] SCHMID M, SCHÜTTLER J, EY K, REICHENBACH M, TRIMMEL H, MANG H. Equipment for pre-hospital airway management on helicopter emergency medical system helicopters in central Europe. Acta Anaesthesiologica Scandinavica. 2011; 55: 583–587.

[89] Ono Y, Tanigawa K, Shinohara K, Yano T, Sorimachi K, Inokuchi R, et al. Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study. International Journal of Emergency Medicine. 2017; 10: 28.

[90] Morton T, Brady S, Clancy M. Difficult airway equipment in English emergency departments. Anaesthesia. 2000; 55: 485–488.

[91] Walsh K, Cummins F. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey. European Journal of Anaesthesiology. 2004; 21: 128–131.

[92] Niazi A, Cummins E, Walsh K. Difficult airway equipment in obstetric units in the republic of Ireland: results of a national survey. European Journal of Anaesthesiology. 2004; 21: 861–863.

[93] Losek JD, Olson LR, Dobson JV, Glaeser PW. Tracheal intubation practice and maintaining skill competency: survey of pediatric emergency department medical directors. Pediatric Emergency Care. 2008; 24: 294–299.

[94] Reeder TJ, Brown CK, Norris DL. Managing the difficult airway: a survey of residency directors and a call for change. The Journal of Emergency Medicine. 2005; 28: 473–478.

[95] Ono Y, Tanigawa K, Shinohara K, Yano T, Sorimachi K, Sato L, et al. Difficult airway management resources and capnography use in Japanese intensive care units: a nationwide cross-sectional study. Journal of Anesthesia. 2016; 30: 644–652.

[96] Georgiou AP, Gouldson S, Amphlett AM. The use of capnography and the availability of airway equipment on intensive care units in the UK and the republic of Ireland. Anaesthesia. 2010; 65: 462–467.

[97] Porhomayon J, El-Solh AA, Nader ND. National survey to assess the content and availability of difficult-airway carts in critical-care units in the United States. Journal of Anesthesia. 2010; 24: 811–814.

[98] Japanese Society of Anesthesiologists. JSA airway management guideline 2014: to improve the safety of induction of anesthesia. Journal of Anesthesia. 2014; 28: 482–493.

[99] Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022; 136: 31–81.

[100] Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia. 2015; 115: 827–848.

[101] Berry E, Kelly S, Hutton J, Harris KM, Smith MA. Identifying studies for systematic reviews. An example from medical imaging. International Journal of Technology Assessment in Health Care. 2000; 16: 668–672.


Abstracted / indexed in

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.

Index Copernicus 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: CiteScore 1.0 (2022) 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.

Submission Turnaround Time

Conferences

Top