Difficult Airway Management in Oncology: An International Delphi Consensus Study (DAMO)

Condition(s) studied

Investigational drug(s) / intervention(s)

Questionnaire Administration: Panellists complete a minimum of three rounds of anonymous electronic questionnaires covering ten clinical domains of difficult airway management in patients with cancer. Each statement is rated on a seven-point Likert scale from 1 (strongly disagree) to 7 (strongly agree), with an optional free-text field that becomes mandatory for any rating of 1 to 3. Each round remains open for a minimum of three weeks, with up to two reminders. No clinical intervention is administered to any patient and no patient-identifiable data are collected.

Study summary

Airway management in patients with cancer carries risks that general difficult-airway guidelines do not address. Tumour in the head, neck, or mediastinum can distort or narrow the airway; previous radiotherapy causes fibrosis and restricts neck movement; low platelet counts increase bleeding during instrumentation; and obstruction may sit below the point at which a breathing tube ends, so that intubation alone does not restore ventilation. Existing international airway guidelines are written for general populations and contain little cancer-specific guidance.

This study uses a modified Delphi method to develop an international expert consensus statement on the prediction, preparation for, and management of the difficult airway in adults with cancer. An international panel of clinicians with expertise in anaesthesiology, intensive care, interventional pulmonology, head and neck surgery, and emergency medicine votes anonymously on a set of candidate statements across ten clinical domains, using a seven-point agreement scale with free-text comment. Voting takes place over a minimum of three rounds. Between rounds, panellists receive anonymised group results and a summary of comments, and statements are revised accordingly.

Consensus is defined a priori as agreement by at least 80 percent of respondents together with a median score of 5 or above; strong consensus requires at least 90 percent agreement with a median of 6 or 7. Statements that do not reach consensus are reported as such and form a prioritised research agenda. Reporting follows the ACCORD reporting guideline for consensus methods.

Eligibility

Primary outcome measure(s)

• Proportion of candidate statements achieving consensus — Through study completion, an average of 4 months
  The percentage of candidate statements meeting the a priori definition of consensus, namely a median rating of 5 or above with at least 80 percent of respondents rating the statement 5 to 7, or a median of 3 or below with at least 80 percent rating it 1 to 3, sustained across two consecutive rounds. Ratings of 4 are included in the denominator. Abstentions are excluded from the denominator and reported separately.

Trial sites (1)

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