The Role of Point of Care Ultrasound During Airway Assessment

Background/Purpose: An assessment of the airway is an essential component of the pre-anesthesia evaluation. The purpose of assessing the airway is to predict potential problems and develop a safe anesthetic management plan. The goal is to avoid an unanticipated difficult airway that can lead to a cannot-ventilate/cannnot-intubate scenario. Current (bedside) airway evaluation methods are subjective, have limited specificity, sensitivity, and often lack diagnostic accuracy. Point- of- care ultrasound of the airway (POCUS-A) has shown promise as an additional airway assessment diagnostic tool, and when used together with current evaluation methods, may serve as a solution for the existing assessment limitations. For example, POCUS-A can be utilized to establish measurements of the upper airway, determine airway size, predict the appropriate diameter of single-lumen and double lumen endotracheal tubes (ETTs), identify upper airway anomalies such as subglottic stenosis, vocal cord pathologies, foreign body obstructions, airway masses, and accurately identify the cricothyroid membrane for emergency airway access as well as identify tracheal rings for ultrasound guided tracheostomy. The purpose of this DNP scholarly project is twofold: 1) to gather baseline data about CRNA current practice patterns related to assessment of the difficult airway, opportunities for POCUS-A, and possible barriers of implementation into clinical practice; 2) to inform CRNAs about the utility of POCUS-A by collating the results of the survey and develop an educational program for two different hospital-based anesthesia departments, located in Kalamazoo and in Marquette. Methods: In order to meet the objectives of this DNP project, a three-part methodologic process was established. First, an IRB approved online survey was distributed to members of the Michigan Association of Nurse Anesthetists (MANA). The purpose was to identify current methods of airway assessment and level of familiarity with POCUS-A, as well as its inclusion in the updated ASA difficult airway management guidelines. Based on the survey results, a curricular scholarly presentation was developed and offered to the providers within the anesthesia departments who requested the information. Lastly, a semi-formal hands-on practicum commenced in the summer of 2023 at a monthly department educational meeting allowing members of the respective departments to practice and gain competency in performing POCUS-A. Results: The survey was distributed to over 2200 CRNA members of MANA. Although the response rate was very low (3%), it did reveal important information. For example, most respondents (99%) rely on and use current methods of airway assessment that have low diagnostic accuracy and are very subjective; 99% do not use POCUS-A for an additional pre- anesthesia diagnostic tool; 82% were unaware of the inclusion of POCUS-A in the updated ASA difficult airway management guidelines; and 74% have an interest in learning more about POCUS-A. The results of the survey were used to develop the scholarly curricular presentation on POCUS-A and offered to the providers within the respective departments. The hands-on practicum took place in June 2023.
Discussion/Conclusion: This project identified a lack of awareness of POCUS-A of members of MANA and providers within the two anesthesiology departments. The members of the anesthesiology departments received a formal didactic presentation specific to POCUS-A via a PowerPoint voice-over lecture and with embedded pictures and videos of the live scanning technique. The attendees of the hands-on practicum provided the authors with favorable feedback and consideration is given for a scholarly presentation at an upcoming MANA meeting.