R. Han, H. Lewis, J. Hammerschlag

Evelina London Children's Hospital, UK

Introduction and aims

Critical incidents and anaesthetic emergencies are fortunately rare in anaesthesia 1, 2. Safety critical industries have developed strategies to improve human performance in these situations.  Check lists, guidelines and protocols can help to structure the approach to the critical event, decrease cognitive load and improve team dynamics 3.

National clinical guidelines are issued and updated by governing bodies such as AAGBI/RAUK/ Royal College of Anaesthetists.

Updates can be communicated via numerous ways including simulation courses, conferences, emails, social media, governance meetings and colleagues. Resuscitation courses (e.g. APLS/ EPALS) are completed every 4 years and may therefore not capture these changes.  Content of local departmental education may vary. In 2018, AAGBI amalgamated all of their guidelines into an easy reference handbook.

The LAST guideline was most recently updated in June 2023.  Importantly, the resuscitation dose of adrenaline was decreased in line with the European and American guidelines. Using this as an example, this survey has been conducted to determine how information is disseminated and how clinicians are made aware of important guideline changes which affect our clinical practice.


An electronic survey was designed using Microsoft Forms. This was distributed via email to both tertiary and non-tertiary centres in and around London. The questions in the survey included each respondents’ role/ grade, type of hospital and scope of practice. Three questions focussed on the LAST guideline update; specifically if, when and how respondents knew about it.


In total there were 171 responses made up of 133 (78%) consultants and 38 (22%) anaesthetic trainees and SAS doctors. 123 (72%) work in a tertiary hospital (62 adult, 40 mixed adult and paediatric and 21 paediatric) and 48 (28%) in a district general hospital.

Over three-quarters of respondents (n=131) were not aware that the AAGBI LAST guideline had changed. Eighty seven (51%) stated they were informed as a result of this survey. Only 39 (22%) knew about the 2023 guideline update and found out in a variety of ways most commonly from a governing body (n=6) or a course / conference (n=6). None found out via a resuscitation course and only one from a local hospital guideline.

Discussion and conclusion

The majority of respondents were not aware that the LAST guidelines had changed. Awareness of the guideline update occurred mainly via a colleague or through the survey. Given the importance of timely adoption of guideline updates in clinical practice, the methods of information dissemination should be multi-faceted to ensure maximal reach.  Consideration may be given to the use of social media or emailing a designated contact at each hospital who could disseminate updates to their department.


  1. Aiudi CM, Oliver JJ, Chowatia PA et al. Perioperative emergencies Who, What, When, Where, Why? J Cardiothorac Vasc Anesth 2021; 35(11): 3248-3254
  2. Bielka K, Kuchyn I, Frank M et al. Critical incidents during anaesthesia: A prospective audit. BMC Anesthesiology 2023; 23:206
  3. Kelly FE, Frerk C, Bailey CR. Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals. Anaesthesia 2023; 78: 458-478
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