Emergency airway management: The need to refine - And redefine - The "state of the art".

Over 15 years ago, Ron Walls and colleagues launched the ational Emergency Airway Registry (NEAR), a multicenter effort o characterize airway management practices in United States US) Emergency Departments (ED).1,2 Data from NEAR helped o demonstrate the competence of emergency physicians in the ost advanced airway management techniques and to spotlight mergent airway management as a defining intervention in the tate-of-art practice of EM. NEAR played a pivotal role in the hisory of EM in the US, helping to cement the role of the emergency hysician in the care of the critically ill. Since its inception NEAR has influenced emergency care internaionally. In this issue of Resuscitation, Hasegawa et al. provide one of he first reports from the Japan Emergency Airway Network (JEAN), multicenter ED airway registry directly modeled after NEAR.3 The uthors’ description of 1486 intubations performed at 10 academic nd community EDs in Japan offers evidence of early success in this ountry’s evolving emergency care system. The authors also point ut gaps and variations in clinical practices, highlighting key areas or improvement. The description is reminiscent of the US EM experience two ecades ago; a nascent specialty struggling to define its scope, pracice and workforce, and striving to prove its worth in the care of the ickest patients. Hasegawa’s study and comments are a testament to the proressive and forward-thinking vision of EM leaders in Japan. The apanese EM community clearly recognizes the advances needed o achieve these goals, including the establishment of organized nd accredited EM residency training, government investment in nd oversight of EM, and a nationally unified approach to the orgaization and quality of emergency care. Most importantly, they are o be congratulated for embracing scientific evidence as an imporant component for achieving these aims.The accomplishments of M in Japan should not be surprising given similar energetic efforts n other Asian countries. As evidenced by the Pan-Asian Resusciation Outcomes Study (PAROS) network, our colleagues in Asia re not only skilled at using but also adept at generating scientific vidence.4 While much of current Asian EM practice is influenced y scientific evidence from the US and other Western countries ith developed emergency care systems, data are now beginning o flow in the opposite direction to impact – and improve – pracices in the West. For example, recent studies from Japan have trongly influenced international recommendations for cardiopulonary resuscitation chest compressions.5–7