Is a Multidisciplinary Difficult Airway Response Team Feasible and Effective?

Medical doctor with assistant intubates male patient in the critical care unit.
The feasibility and effectiveness of the DART system, a multidisciplinary team-based approach to managing difficult airways, was assessed at a tertiary medical center.

Managing difficult airways at a tertiary care institution is feasible and effective via the application of the Difficult Airway Response Team (DART) system’s multidisciplinary team-based approach, according to study findings presented at the AAO-HNSF 2022 Annual Meeting and OTO Experience, held in Philadelphia, PA, September 10 to 14.

The DART model was created out a need to improve the management of difficult and emergent airways in health care settings. In the current study, researchers sought to evaluate the effect of this multidisciplinary team-based program on difficult airway management at a single tertiary academic medical center.

The retrospective study involved emergency medicine (EM), acute care surgery (ACS), pulmonary and critical care medicine, anesthesiology, and otolaryngology (ENT). The medical center’s activation criteria for the DART system included: (1) a difficult airway determined by an airway provider, and (2) an emergent airway requiring intervention within less than 10 minutes. The study analysis involved data obtained through surveys following events and through chart review.

The researchers identified 144 DART events (average 5.3/month) from August 2019 to October 2021, about a quarter of which did not meet both criteria. The researchers found that 66 DART activations had been anticipated, whereas 115 (79.9%) involved patients who had not been categorized as having a difficult airway. The analysis found that anesthesia achieved the airway in 62 events, ENT in 33 events, and critical care in 11 events, and that transoral intubation ± videolaryngoscope achieved the majority of airways. Surgical airways were performed at bedside in 8 cases and in the operating room in 2 cases. Existing tracheostomy was involved in 23 events, and 3 airway-related deaths occurred.

Study limitations include its single-center and retrospective design.

Researchers concluded that “Implementing a multidisciplinary team-based approach to managing difficult airways at a large tertiary care institution was feasible and provided a solution to recent airway events.” They added that DART may be enhanced via ongoing DART debriefing sessions, surveys, and multidisciplinary grand rounds.


Kuhar H, Schofield ML, Besecker BY, Lyaker MR, Spitzer CR. Assessing the impact of difficult airway response team (DART) on airway emergency outcomes. Otolaryngol Head Neck Surg. 2022;167(1 suppl):P16.