Difficult Airway Algorithm

24 Sep

Heard AM, Green RJ, Eakins P.

  • Australian anesthesiologists designed an evidence-based difficult airway algorithm and trained their staff in its procedures
  • Training included 1hr “dry lab” using mannequins, plus a “wet lab” using intubated sheep who were being euthanized for medical research

HIGHLIGHTS:
  • First step is always needle cric, because:
    • it is easy to remember,
    • the required equipment is readily accessible,
    • and is a temporizing measure
  • All pathways involve middle step of jet ventilation and stabilization
  • All endpoints involve a cuffed endotracheal device

 

  • Scalpel bougie and neck dissection had the highest success rates (100%).
  • Scalpel bougie was the quickest (39 seconds mean). They observed thousands of these procedures but only reported success rates and time to successful completion for 10.
  • Scalpel bougie is most useful for airways when air cannot be aspirated with needle cric (ie bloody) but external anatomy is still palpable.
  • Melker is their favorite Seldinger technique airway device when compared with 3 others

Submitted by M. Smith.


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