Strategies to reduce the risk of unrecognised oesophageal intubation: a survey of Difficult Airway Society members

TY - JOUR

T1 - Strategies to reduce the risk of unrecognised oesophageal intubation

T2 - a survey of Difficult Airway Society members

AU - Majumdar, Moon Moon

AU - Silvey, Natalie

AU - Chakladar, Abhijoy

AU - McGuire, Barry

AU - O'Sullivan, Ellen

AU - McNarry, Alistair F.

N1 - Publisher Copyright: © 2025 The Authors

PY - 2025/6

Y1 - 2025/6

N2 - Background: Despite multiple initiatives and consensus guidelines, preventable deaths from unrecognised oesophageal intubation continue worldwide. We aimed to establish what different organisations are doing to reduce the risk of unrecognised oesophageal intubation. Methods: This was a cross-sectional survey of Difficult Airway Society (DAS) members using an internet-based survey platform. Members were invited to participate via e-mail over a period of 10 weeks (28 March to 07 June 2023). Results were reported according to the CROSS checklist. Results: The response rate was 39% (819/2125). About 50% (402/799) of respondents were providing training to reduce the risk of unrecognised oesophageal intubation and 9% (69/799) were planning to. Most of the training (69%; 310/449) is multidisciplinary. However, almost one-third of respondents (31%; 246/799) were from departments that were not planning any training. Non-training-related strategies (including but not limited to increased use of videolaryngoscopy, increased use or improving the interpretability of waveform capnography) were implemented in 39% (297/765) of respondents' departments and planned in 8% (60/765). Nearly one-third (31%; 237/765) were not planning any non-training interventions to reduce risk. Of those who responded, 17% (130/765) were from departments not planning any strategies to reduce the risk of unrecognised oesophageal intubation. Two-person verbal confirmation of capnography was considered ‘extremely’ or ‘very’ helpful by 59% (411/702) of respondents. Conclusions: Our study suggests that uptake of preventative strategies to reduce the risk of unrecognised oesophageal intubation remains inadequate. The authors suggest it is now time for the Royal College of Anaesthetists, DAS, and the General Medical Council to mandate strategies to reduce the risk of unrecognised oesophageal intubation.

AB - Background: Despite multiple initiatives and consensus guidelines, preventable deaths from unrecognised oesophageal intubation continue worldwide. We aimed to establish what different organisations are doing to reduce the risk of unrecognised oesophageal intubation. Methods: This was a cross-sectional survey of Difficult Airway Society (DAS) members using an internet-based survey platform. Members were invited to participate via e-mail over a period of 10 weeks (28 March to 07 June 2023). Results were reported according to the CROSS checklist. Results: The response rate was 39% (819/2125). About 50% (402/799) of respondents were providing training to reduce the risk of unrecognised oesophageal intubation and 9% (69/799) were planning to. Most of the training (69%; 310/449) is multidisciplinary. However, almost one-third of respondents (31%; 246/799) were from departments that were not planning any training. Non-training-related strategies (including but not limited to increased use of videolaryngoscopy, increased use or improving the interpretability of waveform capnography) were implemented in 39% (297/765) of respondents' departments and planned in 8% (60/765). Nearly one-third (31%; 237/765) were not planning any non-training interventions to reduce risk. Of those who responded, 17% (130/765) were from departments not planning any strategies to reduce the risk of unrecognised oesophageal intubation. Two-person verbal confirmation of capnography was considered ‘extremely’ or ‘very’ helpful by 59% (411/702) of respondents. Conclusions: Our study suggests that uptake of preventative strategies to reduce the risk of unrecognised oesophageal intubation remains inadequate. The authors suggest it is now time for the Royal College of Anaesthetists, DAS, and the General Medical Council to mandate strategies to reduce the risk of unrecognised oesophageal intubation.

KW - airway management

KW - capnography

KW - education

KW - training

KW - unrecognised oesophageal intubation

KW - videolaryngoscopy

UR - https://www.scopus.com/pages/publications/105000641973

U2 - 10.1016/j.bjao.2025.100390

DO - 10.1016/j.bjao.2025.100390

M3 - Article

C2 - 40212104

AN - SCOPUS:105000641973

SN - 2772-6096

VL - 14

JO - BJA Open

JF - BJA Open

IS - C

M1 - 100390

ER -