• Br J Anaesth · Dec 2024

    Multicenter Study

    A two-person verbal check to confirm tracheal intubation: evaluation of practice changes to prevent unrecognised oesophageal intubation.

    • Thomas Cloke, Catherine Ross, Paula Joy, Anthony Carver, Thomas E Potter, Dani Padman, Kate Kanga, Imran Ahmad, Kariem El-Boghdadly, Fiona E Kelly, and Timothy M Cook.
    • Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals NHS Foundation Trust, Bath, UK. Electronic address: tecloke@gmail.com.
    • Br J Anaesth. 2024 Dec 1; 133 (6): 130713171307-1317.

    BackgroundDeaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon dioxide) or as a two-step process (adding identification of the tracheal tube passing through the vocal cords during videolaryngoscopy).MethodsIn two hospitals we introduced two-person checking of tracheal intubation. In one hospital this involved the one-step process and in the other the two-step process. We used anonymous online questionnaires before, during, and after these changes to collect opinions from anaesthetists and their assistants regarding the feasibility and acceptability of these changes.ResultsMost intubators (116/149, 78%) and intubators' assistants (70/72, 97%) reported that the two-person verbal intubation check would reduce the likelihood of unrecognised oesophageal intubation. Benefits and lack of negative aspects were reported for both one-step and two-step two-person intubation checks in both centres. Intubators judged that the checks improved communication and teamwork (118/149, 79%); intubators' assistants reported feeling more empowered to voice concerns if needed (69/72, 96%), a flattened team hierarchy (53/72, 74%), and feeling more valued as team members (64/72, 89%). Most intubators (122/149, 82%) and intubators' assistants (68/72, 94%) planned to continue using the two-person intubation check for all future intubations.ConclusionsOur results suggest that a two-person verbal intubation check is feasible and acceptable to all members of the intubating team.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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