National Audit Project Four, or NAP4 as it is commonly known, which examined major complications of airway management in anaesthesia, emergency departments and intensive care, has been widely acknowledged as a milestone in airway management research. A seminal work, it was designed to determine what type and how often airway devices are used, how often major complications occur, what do they consist of and what can be learnt from them to reduce their frequency and consequences. In the opinion of many, this was an objective largely achieved.
Its legacy is not yet clear, but I would suggest it is not only the content of the report that has determined its success to date, but also the ease with which it can be accessed and how easy it is to navigate through it and find the information you need. Each of the main chapters has a quick summary, a review of what is already known, a case review, data analysis, discussion, and finally, clear learning points and recommendations. It has quickly become a constant and valued source of reference. In addition, those organisations involved with NAP4 are to be commended, not only for making the report itself easy to find and free to download, but also making available all the presentations from launch day, as well as podcasts of the lectures, available on the Royal College of Anaesthetists web-site.
It might be tempting to dismiss NAP4 as being of local UK interest only, but this would be a mistake, since many of the themes, results and conclusions, are likely to have a much wider, if not universal, interest and significance. Encouragingly, NAP4 has been the subject of international, as well as domestic lectures at key conferences since its publication. Notably, one of the authors of NAP4 was invited to give a presentation at the Society of Airway Management (SAM) annual conference in the USA in 2011. A challenge was issued to the audience, ‘dismiss the findings of NAP4 as not relevant to your (local, institutional, national) practice if you like……but please do not do so until you have collected robust data to show it is not relevant to your practice’.
With the high profile and success of NAP4, I was curious to know more about its predecessors and what the future might hold for the next series of reports. I was aware of NAP3, ‘Major Complications of Central Neuraxial Block in the UK’, but I was not aware of NAPs one and two. NAP1 examined the supervisory role of consultant anaesthetists, and NAP2, the place of mortality and morbidity review meetings. The report and findings for both can be downloaded from the Royal College of Anaesthetists web-site.
We already know NAP5 will report on ‘Accidental Awareness during General Anaesthesia’. The project was officially launched on 1st June, seeking notification of all reports of accidental awareness during general anaesthesia (AAGA) reported between 1st June 2012 and 31st May 2013. As with NAP4, every UK hospital has agreed to participate. The Clinical Lead for NAP5 is Prof Jaideep Pandit, who will work closely with Dr Tim Cook, the College Advisor for National Audit Projects.
The process of selecting the subject for NAP5 may have provided us with some clues as to the possible subjects for NAP6 and beyond. Among the topics proposed for NAP5 were ‘Anaphylaxis’, ‘Dental damage’, ‘Obesity – incidence and complications’, ‘Recovery Room complications’, ‘Tracheostomy: complications’ and ‘Post-operative nausea and vomiting’. All worthy subjects, but with the request for re-submissions for NAP6 unlikely for another 12 months, perhaps a new subject might come to prominence and prove irresistible. Time will tell.