Preventing and Fighting Airway Fires

The risk of fire, though small, is virtually always present during surgical procedures. Extrapolating from data published by the Pennsylvania Patient Safety Authority in 2012, ECRI Institute estimates that 200 to 240 surgical fires occur nationally each year, making the frequency of their occurrence comparable to that of other surgical mishaps. (ECRI Institute "Surgical Fire Prevention"). Airway fires, which can be particularly harmful to patients, constitute about 21% of these surgical fires and often account for the one or two fatal surgical fires that occur each year ("Airway").

Although methods for reducing the risk of airway fires have been available for decades, patients are still being seriously injured by them. In addition, healthcare facilities face significant liability risks for airway fires. According to a 2004 analysis of the American Society of Anesthesiologists' (ASA) Closed Claims Project database, 100% of the claims for airway fires resulted in payment, and such cases also had the highest settlement amounts (Kressin).

Between mid-2006 and February 2007, the Pennsylvania Patient Safety Authority, through its mandatory statewide event-reporting system designed to track serious events in Pennsylvania hospitals, received six reports of airway fires that resulted in extensive airway injuries. Each incident occurred during bronchoscopic laser surgery when a fiberoptic laser probe tip ignited oxygen inside the patient's airway. Three additional reported airway fires appear to have been caused by electrosurgical or electrocautery units igniting substances at the surgical site, but no significant physical injuries were reported. ("Airway")

ASA recognizes the risk of airway fires and addresses the topic in its "Practice Advisory for the Prevention and Management of Operating Room Fires." The advisory was adopted in the fall of 2007 and published in May 2008, and was updated in February 2013. In the advisory, ASA describes airway fires as "a specific type of surgical fire that occurs in a patient's airway. Airway fires may or may not include fire in the attached breathing circuit" (Apfelbaum et al.). ECRI Institute participated in the...