Anaes SAQs · Airway management

The unanticipated difficult airway: the DAS 2015 algorithm and the Vortex approach

A second-part SAQ on the unanticipated difficult airway. The DAS 2015 algorithm — Plan A the optimised initial intubation (three attempts, BURP, bougie, video laryngoscopy, exit on the third failure or falling saturation, fourth attempt only by a more experienced colleague); Plan B the second-generation supraglottic airway (i-gel, ProSeal, Supreme) and the stop-and-think pause; Plan C the final two-person face mask ventilation with adjuncts and the reduced cricoid; Plan D the CICO and the immediate scalpel-bougie cricothyroidotomy. The Vortex of Chrimes — three lifelines (face mask, supraglottic airway, endotracheal tube) converging on a central CICO zone, each capped at three best attempts, designed for crisis resource management and universal applicability. The DAS versus Vortex (sequential versus convergent, same endpoint). The scalpel-bougie technique (extend the neck, transverse stab with a number-10 blade, turn the blade so the sharp edge points caudally, bougie down the blade, railroad a lubricated 6.0 mm cuffed tube, confirm with capnography). The human factors (call for help early, limit the attempts, declare the failure, overcome the cognitive barrier to the scalpel).