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

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.

Inclusion Criteria: * Substantial current clinical practice involving airway management in patients with cancer, in anaesthesiology, intensive care medicine, interventional pulmonology, head and neck surgery, or emergency medicine At least five years of independent practice following completion of specialist training Demonstrated scholarly contribution to the field, evidenced by peer-reviewed publication, invited lecturing, or a leadership role in a relevant professional society or guideline-development body Willingness to complete all planned Delphi rounds and to review the final manuscript Sufficient written English to complete the survey instrument without translation Membership of the study Steering Committee, whose members do not vote in any round Fewer than five years of independent practice following specialist training No current clinical practice involving airway management in patients with cancer Participation as a pilot tester of the Round 1 instrument, whose responses are excluded from all consensus calculations Exclusion Criteria: \-