Availability of advanced airway equipment on obstetric units: a survey of academic obstetric anesthesia directors in the United States

Background: Obstetric patients have a higher incidence of failed tracheal intubation compared to non-pregnant patients. The accessibility of advanced airway equipment is crucial to managing difficult airways. The Obstetric Anaesthetists’ Association and Difficult Airway Society (OAA/ DAS) guidelines for the management of difficult and failed tracheal intubations recommend having a video laryngoscope immediately available for all obstetric general anesthetics. The objective of this study was to identify the availability of advanced airway equipment on obstetric units in American academic medical centers, thereby assessing preparedness for managing the difficult airway. Methods: A survey was sent to academic obstetric anesthesia directors in the United States. The primary outcome was the proportion of obstetric units that have dedicated advanced airway equipment, specifically video laryngoscopy. Univariate statistics were used to characterize survey responses. Results: Fifty-eight directors completed the survey [59.7% response rate (95%CI: 49.3–69.6)]. All respondents (100%; 95%CI: 93.8–100%) reported having a dedicated video laryngoscope. There was no difference in the number of video laryngoscopes available on the obstetric unit when stratified by annual delivery volume. Only 26 (47%) and 45 (78%) responding units had percutaneous tracheostomy and cricothyrotomy kits available, respectively. Conclusions: The results suggest that the majority of obstetric units have the appropriate equipment for initial difficult airway management; however, some do not stock equipment for surgical airways. Given the potential morbidity and mortality associated with difficult or failed intubation, it is imperative that all units evaluate their ability to access both rescue (e.g. video laryngoscopy) and surgical airway equipment.