The quick look airway classification. A useful tool in predicting the difficult out-of-hospital intubation: experience in an air medical transport program

The unpredictable nature of the out-of-hospital care environment poses unique challenges for active airway management techniques. This descriptive study was conducted in the helicopter air medical transport (AMT) environment for a period of 32 months to determine whether initial direct airway visualization classification may provide a useful tool to predict the difficulty of intubation. Data extracted from documented oral intubation attempts included initial airway visualization grade, number of attempts, final airway management method, and procedural complications. Oral intubation was attempted on 429 patients. Initial airway visualization grades were found with the following frequency for grades I through IV: 65.6%, 21.5%, 8.6%, and 5.4%, respectively. Similarly, the average number of attempts was 1.34, 1.65, 1.97, and 2.39, respectively. The serious complication rate was 24%, 46%, 62%, and 65%, respectively. A statistically significant correlation (Spearman's rho) was found between increasing grade and both the number of intubation attempts (0.52) and the number of complications (0.45). Initial visualization classification may serve as a useful indicator in the out-of-hospital environment to help anticipate the difficulty of intubation and the need for early alternative airway management strategies. In this program, such classification is used to monitor airway management skills.