(1279) Institutional Development and Outcomes of Difficult Airway Response Team: A Single-Center Experience

Introduction: Institutional development and experience with Difficult Airway Response Teams (DART) are crucial for improving patient outcomes during difficult airway adverse events. Johns Hopkins published a landmark article addressing the difficult or failed airway with the development of DART, setting a precedent for other institutions. This study examines our institution's DART activations and airway management outcomes, comparing our experience to that of Johns Hopkins.

Methods: The development of DART Team involved gaining hospital leadership’s support and approval, assembling the multidisciplinary team, equipment, and cross-discipline teaming and training. This required a concerted effort among Anesthesia, Critical Care, Emergency Department, Nursing, Respiratory Therapy, and Trauma and Acute Care Surgery. DART education included difficult airway course, simulation exercises, and review during the Institutional Resuscitation Committee meetings, ensuring comprehensive training and preparedness across all involved disciplines. A retrospective analysis was conducted on all code blue activations at our institution from January 2021 to May 2024. Data collected included the number of code blue calls, DART activations, the methods used for airway management, and the outcomes of these interventions. The primary focus was on the success rates of different airway management techniques and the incidence of airway-related mortality.

Results: During the study period, there were 500 code blue activations. Of these, 34 (6.8%) required DART activation. Airway management was successfully achieved non-surgically in 31 cases (91.2%), using video laryngoscopy (n=22), tracheostomy tube replacements (n=5), and direct laryngoscopy (n=4). Surgical airways were performed in 3 cases (0.6 %). There was one airway-related death, which occurred despite strict adherence to difficult and failed airway algorithms.

Conclusions: Our institution's experience mirrors that of Johns Hopkins, with a similar rate of DART activations (6.8% vs. 7.5%) and surgical airway interventions (0.6% in both). Non-surgical techniques, particularly video laryngoscopy, were predominantly successful in securing airways during these events. Further studies are needed to optimize DART interventions and reduce airway-related mortality.