The 2015 DAS Guidelines
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- Lucy Payne
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1 The 2015 DAS Guidelines
2 Housekeeping & provenance
3 Housekeeping & provenance Preparation for intubation Algorithms New Plans A-D New features
4 Housekeeping
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8 ???
9 ??? Guidelines Group Commissioned
10 ??? Guidelines Group Commissioned
11 Guidelines working group Mansukh Popat Cyprian Mendonca Al McNarry Anil Patel Ellen O Sullivan Ravi Bhagrath Viki Mitchell
12 Guidelines working group Mansukh Popat Cyprian Mendonca Al McNarry Anil Patel Ellen O Sullivan Ravi Bhagrath Viki Mitchell Nick Woodall Chris Frerk Imran Ahmad
13 Revision process Is there a need for revision?
14 Revision process Is there a need for revision? Literature search:
15 Search terms Aintree intubating catheter, Airtraq, airway device, airway emergency. Airway Management, Ambu ascope, backward upward rightward pressure, Bonfils, Bullard, Bronchoscopy, BURP manoeuvre, can t intubate can t ventilate, C-Mac, Combitube, cricoid pressure, cricothyroidotomy, cricothyrotomy, C trach, difficult airway, difficult intubation, difficult laryngoscopy, difficult mask ventilation, difficult ventilation, endotracheal intubation, esophageal intubation, Eschmann stylet, failed intubation, Fastrach, fiber-optic scope, fibreoptic intubation, fiberoptic scope fibreoptic stylet, fibrescope Frova catheter, Glidescope, gum elastic bougie, hypoxia, i-gel, illuminating stylet, jet ventilation catheter, laryngeal mask, laryngeal mask airway supreme, Laryngoscopy, lighted stylet, light wand, LMA supreme, Manujet, McCoy, McGrath, nasotracheal intubation, obesity, oesophageal detector device, oesophageal intubation, Pentax airway scope, Pentax AWS, ProSeal LMA,, Quicktrach, ramping, rapid sequence induction, rapid sequence induction, Ravussin cannula, Sanders injector, Shikani stylet, sugammadex, supraglottic airway, suxamethonium, tracheal introducer, tracheal intubation, Trachview, Tru view, tube introducer, Venner APA, videolaryngoscope, videolaryngoscopy.
16 Revision process Is there a need for revision? Literature search: new abstracts, 584 selected for full text review
17 Revision process Is there a need for revision? Literature search: new abstracts, 584 selected for full text review Working group meetings
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20 Revision process Is there a need for revision? Literature search: new abstracts, 584 selected for full text review Working group meetings Many draft versions
21 Revision process Is there a need for revision? Literature search: new abstracts, 584 selected for full text review Working group meetings Many draft versions Suggestions and comments from DAS members
22 Revision process Is there a need for revision? Literature search: new abstracts, 584 selected for full text review Working group meetings Many draft versions Suggestions and comments from DAS members Suggestions and comments from expert panel
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29 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant
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31 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant
32 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant Videolaryngoscopy included
33 Videolaryngoscopes Channeled Non -channeled
34 Gill, 2013 Device Availability Airtraq 59% Glidescope 33% C Mac 23% McGrath S5 12% AP advance 11% McGrath Mac 9% Pentax AWS 8% Kingvision 1%
35 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant Videolaryngoscopy included 3 attempts
36 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant Videolaryngoscopy included 3 attempts (+1)
37 Optimising success on first attempt at Laryngoscopy Position, pre-oxygenation, muscle relaxant Videolaryngoscopy included 3 attempts
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40 It s about oxygenation
41 It s about oxygenation 2 nd generation SADs
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43 It s about oxygenation 2 nd generation SADs
44 It s about oxygenation 2 nd generation SADs (3 attempts)
45 It s about oxygenation 2 nd generation SADs (3 attempts) Plan continuation bias
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50 Plan D - Technique
51 Plan D - Technique Not enough evidence to choose one particular technique
52 Plan D - Technique Not enough evidence to choose one particular technique There are enough reasons to choose just one technique
53 Going?
54 Going? Going?
55 Surgical technique chosen
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58 Airway Assessment - Cricothyroid membrane Tracheal rings and cricoid cartilage String of pearls
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65 Cricothyroid membrane not palpable - vertical skin incision
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68 New / Updated Features Pre-oxygenation & maintenance of oxygenation
69 Pre-oxygenation & maintenance of oxygenation
70 Pre-oxygenation & maintenance of oxygenation
71 New / Updated Features Human Factors
72 Human Factors Investigation Tool THREATS Procedures Work Preparation Job Factors Person Factors Competence & Training Communication Team Work Supervision Organisational/ Safety Culture Work Environment Human-Machine Interface Tools and Equipment SITUATION AWARENESS Attention Detection and Perception Memory Interpretation Decision Making Assumption Response Execution ACTION ERROR Omission Timing Sequence Quality Selection Communication errors Rule Violations ERROR RECOVERY Behavioural Response and Detection Cues
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75 New / Updated Features Rapid Sequence Induction
76 Rapid sequence induction
77 Rapid sequence induction Same algorithm as elective
78 Rapid sequence induction Same algorithm as elective Sux vs Roc FMV during RSI Cricoid off (A & B)
79 2015 Guidelines summary
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82 Optimising success on first attempt Position, pre-oxygenation, muscle relaxant
83 Optimising success on first attempt Position, pre-oxygenation, muscle relaxant 3 attempts
84 Optimising success on first attempt Position, pre-oxygenation, muscle relaxant 3 attempts Videolaryngoscopes are in
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86 2 nd generation SADs
87 2 nd generation SADs (3 attempts)
88 2 nd generation SADs (3 attempts) If you can ventilate, Stop and Think!
89 Complex decision making
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100 Human factors in the development of complications of airway management: Flin et al Anaesthesia 2013; 68:
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103 A B C D
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