(025) Airway-related Mortality: A Literature Review and Concept Analysis

Introduction: The definition of airway-related mortality is often ambiguous and grouped into the same category as anesthesia-related death, respiratory-related death, or general death. We conducted a concept analysis to define the theoretical framework of airway-related mortality to advance research, education, and professional practice.

Methods: Following PRISMA guidelines, we conducted a systematic literature review and a concept analysis on airway-related mortality. We searched MEDLINE, CINAHL, Embase, Web of Science, and Scopus databases from inception to December 2022. Data were extracted on study design, patient characteristics, clinical outcomes, and complications. Walker & Avant's concept analysis framework guided our qualitative analysis. We included original studies of individuals requiring airway management that reported incidences of death related to an inability to secure the airway. We excluded simulation-based and non-peer-reviewed research.

Results: Twenty-five studies with a total sample size of 8.436 met the eligibility criteria for inclusion. Eligible studies included anesthesia-related litigation files (16%) and incident reports (44%), electronic medical records (40%), interviews (8%), and difficult airway intubation registries (8%). Studies were observational and primarily retrospective (60%). No consistent definition of airway-related mortality was used in the literature. The concept analysis resulted in a unified definition of airway-related mortality as loss of life involving the airway where an inability to oxygenate and an inability to ventilate amid attempts at securing the airway is the proximal cause of death.

Conclusions: Airway-related mortality is a nuanced concept that incorporates several attributes, but no widely accepted definition exists in the literature. The absence of a conceptual model has impeded progress in understanding and addressing the causes of airway-related mortality. Researchers, clinicians, and educators can use this newly-defined concept of airway-related mortality to implement preventative measures to improve patient safety.