Management of Airway Fires in the Operating Room

Introduction

• Airway fires can cause significant damage if not promptly addressed.
• The operating room fire crisis checklist is essential for guiding the anesthesia provider and the operating room team in such situations.

Immediate Actions by Anesthesia Provider

1. Extinguish the Fire

   • Stop the accelerant and fuel:
     • Turn off the oxygen supply.
     • Disconnect the circuit from the patient.
     • Remove the airway device.
   • Remove any additional flammable materials.
   • Pour saline into the airway to reduce further burning.

2. Re-establish Ventilation

   • Use a bag and mask with room air.
   • Consider timely placement of an endotracheal tube:
     • Prevents hypoxia.
     • Secures the airway in case of airway swelling.

3. Assess Airway Damage

   • Evaluate the extent of airway damage.
   • Retrieve any residual debris.

4. Ensure No Secondary Fire

   • Check surgical field, drapes, and towels.
   • Use a fire extinguisher if the fire cannot be extinguished.
   • Evacuate the patient if the fire persists.
   • Close the operating room door and turn off all gas supplies.

Post-Fire Actions

• Discuss Patient Condition
  • Collaborate with the operating room team to develop a plan of action and treatment.
• Preserve Evidence
  • Save any materials involved in the fire for evaluation.

Debriefing

• Conduct a debriefing session with the operating room team and other providers.
  • Address:
    • Factors that led to the fire.
    • Emotional impact on the team and providers involved.