7 thoughts on “PHARM Podcast 004 – Own the Airway”

  1. Minh and Toby,

    Enjoyed the interview very much. Thanks for sharing your experience.

    It’s my opinion that the emergency airway literature overemphasizes the importance of “first-pass success.” When teams know that’s the metric of success by which they’re being measured, they’re incentivized to continue attempts at laryngoscopy past when the steep portion of the oxyhemoglobin dissociation curve has been reached, which can quickly lead to critical hypoxia. But I don’t think “success (in any number of attempts) without hypoxia” is correct either, because then there’s no incentive to correctly position the patient and maximize the first attempt. We don’t want JUST first-attempt success or JUST success without hypoxia. We want both. At UC Health Air Care & Mobile Care in Cincinnati, USA, we’re now instead using a metric we call DASH-1A (Definitive Airway Sans Hypoxia on the 1st Attempt). The concept has worked well for us.

    Thanks again!

  2. thanks Bill. interesting sounding concept with catchy title!
    Folks, I interviewed Bill a couple of weeks ago and its an upcoming episode on the Prehospital podcast. It would have been great to talk about DASH -1A… in fact Bill can you send me a quick recording of yourself describing your concept so I can put together another podcast perhaps on Own the airway on LITFL?

    1. Good point Bill and love the acronym.
      In this paper “Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study ” by Hasegawa et al in Annals EM (published ahead of print). They show a significant increase in complications after 2 attempts. Their data form is the same as the NEAR in USA and so different to ours. I would love to use our multi centre registry in aus/ nz ( 15 sites showing interest now) to examine the the effects of each additional attempt. And congratulations to the Japanese team for setting up their multi centre registry by the way.

    2. Minh, Sure, I’d be happy to, but probably won’t have a chance until next week. Thanks for the invitation.

  3. Heard a great line the other day…which kind of crystallised the whole concept of first past success w/o critical hypoxia for me.

    “Airways are like willies – the more you fiddle with them, the harder they get!”

    So I like the DASH-1A concept

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