Anaes · Airway management

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

Also known as DAS 2015 algorithm · Difficult Airway Society algorithm · Vortex approach · CICO · Cannot intubate cannot oxygenate · Front-of-neck access · FONA · Scalpel-bougie cricothyroidotomy

The unanticipated difficult airway is the airway that fails on induction, in a patient the preoperative assessment did not flag, and it is the single most examined emergency in the airway viva because it is the crisis that kills. Two frameworks now govern the response, and the candidate must know both. The Difficult Airway Society 2015 algorithm is the structured, sequential UK standard — Plan A the optimised initial intubation, capped at three attempts; Plan B the second-generation supraglottic airway rescue; Plan C the final face mask ventilation attempt; and Plan D the cannot-intubate, cannot-oxygenate endpoint at which front-of-neck access is performed without delay. The Vortex approach of Chrimes is the simplified cognitive tool that arranges the same three lifelines — face mask, supraglottic airway, endotracheal tube — as converging lanes around a central CICO zone, each capped at three best attempts, designed for crisis resource management and universal applicability across anaesthesia, the emergency department, and intensive care. This suite examines the two frameworks against each other, the scalpel-bougie cricothyroidotomy technique, the human factors that decide the outcome, and the preoxygenation and the safe apnoea period that buy the time the algorithm runs in. Anchored to contemporary evidence on the physiological difficult airway, the safety of the emergency intubation, the syndromic difficult airway, and the measured preoxygenation.