Airway management practices at German university and university-affiliated teaching hospitals--equipment, techniques and training: results of a nationwide survey

BACKGROUND: Until recently, Germany did not have national airway management guidelines. This survey collected comprehensive data on departmental airway management practices from German teaching institutions to identify weaknesses, and the results are presented here. German national airway guidelines were formulated by an expert group on the basis of these data and the current evidence in the literature. METHODS: Questionnaires were mailed to the directors of 452 university and university-affiliated anaesthesia departments. They were asked to respond to 39 questions on the use of particular equipment and techniques, management of the difficult airway and training in airway management. RESULTS: Two hundred and twelve questionnaires were returned. Many alternative devices for endotracheal intubation, such as the Bullard laryngoscope, the Bonfils laryngoscope and the Trachlight, are not used in the majority (80%) of departments. Thirty-six per cent of departments do not have difficult airway carts. No departmental difficult airway management plan is used in 22% of departments. Patients are not provided with written information on their personal airway management difficulties in 14% of departments. Structured training in the form of block rotation is offered in only 29-40% of departments. Although trainees perform fibreoptic intubation (FOI) in most departments, appropriate training in FOI is not available in some departments (8%). CONCLUSION: There are deficits in various areas of airway management, in particular training and the use of algorithms. International guidelines and recommendations are not followed by a large number of German teaching institutions. The provision of German national airway guidelines should improve this situation.