Adults

Failed Airway

Diagnosis

2 unsuccessful intubation attempts by an airway expert in a patient under general anesthesia

Diagnosis

2 unsuccessful intubation attempts by an airway expert in a patient under general anesthesia

  1. Call for help and a code cart

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Get difficult airway cart

  3. Monitor elapsed TIME, intubation ATTEMPTS, and SpO2

    • Limit attempts to 3 by initial provider plus 1 attempt by other airway expert (“3+1”)

  4. Bag-mask ventilation with 100% Oxygen

    • Is ventilation adequate?
      • Maintaining adequate SpO2?
      • Capnographic evidence of adequate ventilation?

  5. Ventilation NOT ADEQUATE

    • Consider/attempt supraglottic airway
      • Optimize patient position
    • If unsuccessful, attempt alternative intubation approaches as you prepare for emergency invasive airwayy
      • Limit to “3+1”
    • If you remain unable to intubate and unable to ventilate, implement emergency invasive airway

    Switch list if ventilation status changes

  6. Ventilation ADEQUATE

    • Attempt alternative intubation techniques
      • Limit to “3+1”
    • Consider doing the procedure with a supraglottic or mask airway
    • Optimize ventilation/intubating conditions
    • Consider invasive airway
    • Consider awakening patient
    • If awakening patient, consider:
      • Awake intubation
      • Complete procedure under local or regional
      • Cancel the procedure

    Switch list if ventilation status changes

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.