Airway management during anesthesia and non-operating room anesthesia. Preliminary data from an international prospective cohort study (STARGATE Study). ​

Abstract Importance: Around 230 million of major surgical procedures are performed yearly around the world. Despite important technological advances, airway management remains a major challenge in anaesthesiology. Limited amount of information is currently available on incidence of major adverse events in patients undergoing airway management during general anaesthesia in OR and NORA settings. Objective: The primary aim of the study is to assess the current incidence of major adverse events during advanced airway management in anaesthesia in patients undergoing elective or emergency surgery performed in the operating room (OR) and in the setting of nonoperating room anaesthesia (NORA). Design, setting, and participants: A preliminary analysis on the international, multicentre, prospective cohort observational study on airway management in operating room and non-operating room anaesthesia (STARGATE) study was performed. The study involved 369 consecutive patients undergoing airway management in all procedures both diagnostic and therapeutic, elective, or emergency, from January 15, 2024, to January 19, 2024, in a convenience sample of 19 sites from 10 countries across 3 continents. Exposures: Advanced Airway management, either Tracheal Intubation or Supraglottic Airway device placement. Main outcomes: The primary outcome of interest was the incidence of major adverse peri-intubation events defined as at least 1 of the following events during airway management occurring within 30 minutes from induction or up to surgical incision: (1) cardiovascular instability, defined as either: systolic blood pressure <65 mm Hg at least once, or systolic blood pressure <90 mm Hg for >30 minutes, or, new or increased need of vasopressors or fluid bolus >15 mL/kg; (2) severe hypoxemia, (peripheral oxygen saturation <80%) or (3) cardiac arrest. Results: Of 454 patients screened, 369 (median age, 58 years; interquartile range [IQR], 44-68 years; 47.4% men) from 19 sites across 3 continents were included. Primary outcome data were available for all patients. Among the study patients, 22.5% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 22.5% of all patients undergoing airway management, followed by severe hypoxemia (0.8%) and cardiac arrest which did not affect any patient of the sample. Overall, peri-intubation events incidence was 22.5%. Conclusions: In this preliminary observational study of airway management morbidity during general anaesthesia in different settings from a convenience sample of 19 sites across 10 countries, major adverse peri-intubation events, particularly cardiovascular collapse were observed oftentimes. Significantly higher incidence of cardiovascular collapse was observed in older patients, patients with higher ASA Score and after Propofol use during induction.