The formulation and introduction of a ‘can't intubate, can't ventilate’ algorithm into clinical practice

Abstract

Summary Both the American Society of Anesthesiologists and the Difficult Airway Society of the United Kingdom have published guidelines for the management of unanticipated difficult intubation. Both algorithms end with the ‘can't intubate, can't ventilate’ scenario. This eventuality is rare within elective anaesthetic practice with an estimated incidence of 0.01–2 in 10 000 cases, making the maintenance of skills and knowledge difficult. Over the last four years, the Department of Anaesthetics at the Royal Perth Hospital have developed a didactic airway training programme to ensure staff are appropriately trained to manage difficult and emergency airways. This article discusses our training programme, the evaluation of emergency airway techniques and subsequent development of a ‘can't intubate, can't ventilate’ algorithm.

Education in airway management

“…Teaching should take into account the level of expertise of the learner. In an ideal setting, novices should start their training on part-task trainers in an airway training room, then progress through more sophisticated modalities, perhaps using cadavers or anaesthetised animals, or animal tissue preparations [49][50][51][52][53]. They should then progress to clinical training under supervision once they have achieved competence using simulation.…”

Endobronchial intubation and scapel‐bougie technique

“…We congratulate Heard et al [1] on their recent publication concerning a 'can't intubate, can't ventilate' (CICV) algorithm. We would like to suggest an important issue for the scalpel-bougie cricothyroidotomy section.…”

“…The use of supplemental oxygen and monitoring of respiratory rate during these techniques is common practice. ASA guidelines recommend the use of clinical signs and ⁄ or monitoring for the presence of exhaled carbon dioxide [1].…”

Can’t intubate, can’t ventilate: lessons from aviation

“…The World Health Organization (WHO) recently published their Safe Surgery Saves lives initiative [1]. The aim is to improve communication amongst the theatre team, encourage safe anaesthetic practice and avoid common surgical complications, as well as giving consideration to potential anticipated problems.…”

“…We congratulate Heard et al [1] on their interesting and informative article on the management of the 'can't intubate, can't ventilate' scenario. We agree that although this is a rare situation, and Kheterpal et al [2] have recently estimated an incidence of 1 in 8840, training in its management is essential.…”