Anaes Vivas · Airway management

Data viva — the DAS 2015 algorithm and the Vortex approach applied to an unanticipated difficult airway

A data viva on the unanticipated difficult airway. The frame is the DAS 2015 algorithm and the Vortex approach applied to a timeline. The reading of the timeline: the preoxygenation end-tidal oxygen as the metric of the safe apnoea period bought; the cap of three best attempts per lifeline or per plan, and the exit to the next on the failure or the falling saturation; the second-generation supraglottic airway as the Plan B rescue (first-generation excluded by NAP4); the STOP-and-THINK pause after a Plan B or Plan C success; the CICO endpoint and the immediate scalpel-bougie cricothyroidotomy (identify the membrane, transverse stab, turn the blade 90 degrees, bougie caudal, 6.0 mm cuffed tube, capnographic confirmation). The DAS versus Vortex (sequential versus convergent, same endpoint). The human factors — the call for help, the assigned roles, the fixation error, the cognitive barrier to the scalpel that made NAP4 find the cricothyroidotomy late. The physiological difficult airway (shock, hypoxia, acidosis) shortening the safe apnoea period to seconds.