Sunday, November 30, 2014

The Airway Algorithm Game

                                      Entering the Airway Vortex
   The SAM 2014 Meeting produced a variety of timely advances in Airway thinking and procedures.
The interesting debate and Competition centering around the ASA  algorithm , the Canadian Airway study group algorithm and the Australian Vortex algorithm was resolved by audience vote in favor of the Vortex.

  The 2013 ASA algorithm notably spelled out a prominent role for video laryngoscopy which reflects common practice trends and thinking in the USA.

  The Canadian study group focussed on defining the differences between the parturient and the standard difficult airway and simplified the thought processes getting one to the surgical options.

  The Vortex concept was appreciated because it gives one a powerful graphic concept of being in a whirlpool with 3 modes to try 1. Bag Valve Mask 2. Laryngeal intubation by the best means available  3. Supraglottic airway rescue...... and should all of these be quickly applied and fail then the surgical option is required.

   The proliferation of airway algorithms seems to suggest that each region has a completely unique body of challenges related to the airway. The customization of airway thought I suppose means that each hospital region has different knowledge base, different equipment, and a non homogeneous group of providers. Standardization is needed now to focus this field, to reduce confusion and increase communication, but there are no forces available to make this happen so we will just put up with the current state of affairs.

  The Vortex appeal is the graphic nature of the presentation and one could argue that in crisis mode the simplest notions are more likely to be remembered and acted upon. The popularity of this new offering may be a sign of consensus developing.