Impact of checklists on peri-intubation care in ED trauma patients

Hi folks
just back from SMACCGOLD. Fun and energising event of the year for me!

You might have heard Tim Leeuwenberg and I had a debate regarding checklists and airway experts

His side of the debate is well summarised here on his excellent blog

I must say he debated very well and was the clear audience favourite. When Cliff Reid polled the expert panel on their opinion, here were the results.

Did they use airway checklists?
Dr Richard Levitan = NO
Dr Keith Greenland = NO
Dr Scott Weingart = YES

Interpret as you may but in my mind the fact that recognised airway experts can disagree on the benefit/safety of checklists for airway management means that experts do not need to use them. Certainly they may choose to use them but that was not the debate topic.

Anyway I was surprised since the debate that an Article in Press in the American Journal of EM came out on perintubation checklists!
Here it is

Impact of checklists on peri-intubation care in ED trauma patients

Key points about the study:
– retrospective, before and after analysis
-underpowered to show outcome differences
– RSI rates significantly more post checklist
– no significant difference in intubation attempts nor success
-no significant difference in haemdynamics nor oxygen desaturation rates with use of checklist
– Mix of anaesthesia and EM docs prior to CL , then 99% EM docs doing intubations post CL so potential confounder

So at least understand the latest evidence and make up your own mind. I am trying to develop and implement a RSI checklist in my aeromedical base and its not as simple as you might think. To my mind the most important thing is training and review. If a CL helps you do that, great. If not, dont get fixated on it. Certainly the evidence is not that clear cut!

4 Comments
  1. Nice debate Minh (and commiseraitons on losing BTW). Debate is always difficult – who is an expert? What actually is a checklist?

    I think we afree – checklists are no panacea on their own. And a top down mandatory intorduction of checklists or introduction of checklists for many procedures may cause more harm than good.

    If you are considering checklist introduction, then make sure

    – their is a NEED eg a high risk, tightly coupled procedure where risk of error can cause harm

    – that understand they are NOT a “how to” for novices. Rather they can help bind a team and facilitate the expert, cogniscent of fact even experts may fail under task saturation and that a team of expets does not equal an expert team (#SimWars proved that!)

    – design is key. Keep brief, use the checklist for checklists at projectcheck.org

    – test checklist and ensure you have institutional buy in, with revision and audit. If no good, chuck out items. Use sim (as genuine airway crises are relatively infrequent) and consult widely – the ANZ airway audit out of RNSH airwayregistry.org.au is excellent place to start

    – understand they are but one extra layer of defence. But will NOT work in isolation

    Whole bunch of references over at kidocs.org and hope to podcast with Minh, James French and Toby Fogg on this down the track…

  2. OK, next time let me defend the indefensible…challenge for #smaccCHICAGO …

    Important to be on record that Minh and I agree on most things and much common ground here. I hope people dont think there is animosity here. There is not.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s