Airway management a matter of life and death

Originally published in QEII Times.

Emergency Medicine Young Researcher’s Grants awarded to help advance discovery and clinical care in emergency medicine

Author: Jennifer Gouchie-Terris

Maintaining an airway is a matter of life or death in a medical emergency, and an area of medicine that requires constant research and innovation. A recent grant from the QEII Foundation is enabling a young researcher to continue studies focused on better understanding the benefits of using an advanced piece of equipment — called a bougie — in airway management, and the role stress plays in accuracy and success rates.

Emergency Medicine Young Researcher’s Grants (EMYRG) were established by the QEII Foundation in 2023 through a legacy gift from the late Raymond L. Roberts. Grants were recently awarded to help foster the growth of early-stage investigators and help advance discovery and clinical care in emergency medicine. The grants support new researchers at the QEII’s Charles V. Keating Emergency and Trauma Centre to establish their research programs and increase competitiveness for external funding.

Up to four grants of $5,000 will be awarded annually, as funds permit.

Dr. Adam Parks, QEII emergency medicine physician, was one of the first two researchers to receive the grant for his project — Accuracy of Bougie Use and Tracheal Clicks During Simulated, Stressful Scenarios: A Cadaveric Study — which aims to provide evidence on how medical providers perform with bougies during stressful scenarios and may help inform airway guidelines.

The grant will significantly help aid Dr. Parks’ research, which aims to help improve the quality of care provided to patients in pre-hospital and emergency department settings. Much of his research focuses on airway management and moving the needle for emergency providers such as physicians or paramedics in terms of improving care provided to critically ill patients.

“The whole premise is that there’s some evidence to show that the bougie may provide benefit in terms of successful airway management and intubation for more experienced providers,” says Dr. Parks. “Physicians who routinely use a bougie seem to have higher success rates, but we don’t have great evidence in the literature for practitioners who don’t use a bougie all the time.’’

Although most airway intubations are straight forward, Dr. Parks says emergency medicine providers always plan for the worst and approach their training as if they’re going to experience difficulty all the time.

The grant allowed Dr. Parks and his team to continue their work on two different studies, the first of which looked at whether paramedics, who don’t frequently perform intubations, can perform well and achieve a high success rate when using the bougie device.

The second study, which is now complete, questioned how stress affects accuracy and success rate.

For this study, about 40 practising paramedics were recruited from throughout the Maritimes and, thanks to Dalhousie University’s Human Body Donation Program, were provided access to four clinical-grade cadavers on which to perform airway management or intubations.

“We’re so fortunate to have the program locally; we’re only one of two healthcare networks in North America to have access to clinical-grade cadavers for research and teaching purposes,’’ he says. “Over the course of two days, we collected all of this information which, showed that paramedics can achieve high success rates with the bougie and really good accuracy.’’

Paramedics taking part in the study were required to perform intubations or airway management in both non-stressful and stressful situations, including time limitations, increased heart rates and loud distracting background noise.

“What we found was that under stress, they were about 70 per cent less accurate or less successful compared to non-stressful conditions, which is a really important finding and speaks to the tremendous impact stress can have on airway providers.’’

The long slender device is beneficial because it is significantly smaller than a breathing tube and allows emergency medicine providers to see exactly where they are going in real time. As one of the only studies that has looked at bougie use for paramedics, Dr. Parks says it provides evidence that after some training, they are able to use the bougie with a great deal of accuracy.

“It empowers them to use some of these more advanced devices and it really shows the pronounced effect that stress can have on performance. Moving forward, it’ll be important for our group to look at what sort of strategies can be introduced in a controlled environment to mitigate the effect of stress on accuracy and success,” says Dr. Parks.

Grants like EMYRG are important to provide junior researchers like Dr. Parks with funding to perform studies early on in their careers. Lack of funding is one of the biggest roadblocks for new researchers.

“Receiving a grant like this and achieving important research outcomes helps us become eligible and attractive when we apply for larger grants in the future,’’ says Dr. Parks.

The QEII Foundation is proud to support junior researchers in their quest to advance health care and is grateful to donors, like the late Raymond Roberts, who choose to leave gifts in their wills to support advancing health care in Atlantic Canada.

According to QEII Foundation charitable giving advisor Geoff Graham, gifts in wills have long had an impact on health care at the QEII in terms of research, equipment, and other areas of need throughout the years.

“We saw that very much so with Mr. Roberts’ gift that had a huge impact in different care areas, especially in research and the EMYRG program that he helped fund,’’ says Geoff.

All supporters can specify how they would like to see their gift make an impact, which Geoff says can be easily done with the help of staff at the QEII Foundation and through a lawyer when drafting or amending a will.

“We make every effort to make sure the gift goes toward the area they would like to fund,’’ Geoff says.

All gifts go toward life-changing care, now and in the future.