Anaesthesia Editorial - Time for a breath of fresh air: Rethinking training in airway management

In this editorial Stuart Marshall and Nicholas Chrimes discuss the challenges for both trainee and consultant anaesthetists in achieving and maintaining 'mastery' in airway management techniques. Particular issues highlighted include:

  • The potential inconsistencies of the traditional apprenticeship model for airway training.
  • The difficulties for consultants in gaining structured training in new techniques
  • The impact of the supraglottic airway on opportunities for trainees to learn basic airway skills 
  • The inadvertent consequence of safer working hours on the number of cases to which trainees are exposed
  • The potential paradoxical effect that a disproportionate emphasis on CICO training could have on the incidence of inappropriate CICO Rescue
  • The importance of emphasising non-technical skills in emergency airway management
  • The crucial role of interprofessional team training
  • Incorporating training with implementation tools such as the Vortex Approach to facilitate prevention of, and priming for, CICO Rescue
  • The importance of anaesthetists training in conjunction with other specialists involved in airway management, such as emergency medicine and intensive care, to promote exchange of ideas and avoid divergent practice.

The authors take the possibly controversial position that not all anaesthetists necessarily need to possess the full set of airway skills and that skills could instead be divided into core and specialised techniques. Criteria for delineating core from specialised skills are outlined. The ability to perform CICO Rescue is highlighted as a core skill which all anaesthetists must possess.

The challenges of ensuring that such a tiered system of airway skills would not limit ready access of patients to these techniques when they are required is also discussed. 

Free full text of this article is available at the Anaesthesia website.


BJA Editorial: Is it time for airway management education to be mandatory?

In this editorial in the British Journal of Anaesthesia's Airway Management issue, Baker et al examine the challenges associated with fulfilling the "ethical obligation for all practitioners to keep up to date through lifelong learning" in airway management.

The editorial includes reference to an innovative e-learning program for airway management based around the Vortex Approach. This Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC) Program is to be trialled as a mandatory program in Veteran's Health Administration hospitals in the United States. The e-learning package includes an avatar based game in which clinicians make context dependent decisions about interventions to establish airway patency. Use of such a model has the potential to provide standardised and engaging airway education in a resource efficient manner. 

The authors also raise some valid issues in relation to mandatory CICO training, in particular concerns that the emphasis on technical training in CICO Rescue could paradoxically lead to an increased incidence of CICO events by creating neglect of training in preventative techniques to optimise success at the upper airway lifelines.

Free full text of the article is available via the BJA website.

Vortex Approach published in the British Journal of Anaesthesia

Just over three years after being released on-line as a free e-book in 2013, an updated version of the Vortex Approach has been published in the peer reviewed literature. While the basic principles remain the same, version 2 of the the Vortex Approach features an updated "implementation tool", some expanded concepts and alters some of the original terminology. In addition some adjunctive tools have been added which work in an integrated fashion with the primary Vortex tool. The objective has been to create an even simpler, more visually-based tool and introduce more precise, language that is easier to use an understand with the hope of enhancing team performance during an airway crisis.

Full text of the BJA article is available here via the BJA website