Elaine Bromiley Case Summary

Complications associated with a difficult airway that cause temporary harm are common but those complications that cause serious injury are rare. It is commonly the easy airways that cause the most harm and lead to death. A good example of this is the Bromiley case. Although this case highlights the importance of communication and leadership within a team, it also demonstrates how a “routine operation” with what was classified as an easy airway, can go wrong and lead to serious harm. In this case Elaine Bromiley’s airway obstructed in the anaesthetic room and became a ‘can’t intubate, can’t ventilate’ (CICV) scenario. It confirms again that a clear plan is needed before any intubation and should any crisis occur this plan should be followed.
These revised airway guidelines provide the clinician with sequential steps for when intubation fails with the main priorities being oxygenation of the patient and limiting the number of interventions. The main reasons for this are to reduce trauma and complications identified by the NAP4 and other publications associated with a difficult airway. Another reason for having a well established management plan is to ensure that the same practice occurs at every hospital trust, as the guidelines will be directly transferrable between them. Having ‘difficult airway trolleys’ as mentioned above, means team members are less likely to come across unfamiliar equipment or techniques when an emergency occurs.

The guidelines are also well supported in relation to pre-operative assessment. Each step of the guidelines can relate to the assessment that is made of mouth opening, neck mobility and the location of the cricothyroid membrane before surgery. Once again this highlights the importance of pre-operative assessment because the clinician will be able to determine if certain rescue techniques are unlikely to be