Difficult Airway Society guidelines for the management of tracheal extubation

Cook Medical welcomes the guidelines for the safe management of tracheal extubation in adult peri-operative practice as developed by the Difficult Airway Society [1]. The authors promote a four-step approach to extubation and describe the performance of ‘at-risk’ extubation that includes the technique of airway exchange catheter-assisted extubation. The authors state “…the only device that is commercially available in the UK for this purpose is the Cook Airway Exchange Catheters”. On behalf of Cook Medical I would like to clarify that the intended use of the Cook® Airway Exchange Catheter is for tracheal tube exchange only. In this application, the Cook Airway Exchange Catheter facilitates the immediate exchange of an in-situ tracheal tube for a replacement tube and is utilised as a temporary airway management device for this purpose. The Cook Airway Exchange Catheter is not intended to remain in the airway thereafter, or for an extended period of time as may be required in the technique of airway exchange catheter-assisted extubation. The aforementioned guidelines, and the findings of NAP4 [2] related to the end of anaesthesia and recovery, both describe the need for a systematic approach to extubation and the availability of appropriate equipment. In response to the clinical need for equipment that is both designed and approved for the intended use, Cook Medical has recently obtained the CE mark for a new Staged Extubation Set.