Difficult Airway Algorithm

1.Assess the likelihood and clinical impact of basic management problems.

A. Difficult ventilation
B.Difficult intubation
C. Difficulty with patient cooperation or consent
D.Difficult tracheostomy
2. Actively pursue opportunities to deliver supplemental oxygen throughout the process of difficult airway management.
3. Consider the relative merits and feasibility of basic management choices:

A. Intubation attempts after

Awake intubation vs. induction of general anesthesia
B. Noninvasive technique for initial Invasive technique for initial
vs.
approach to intubation approach to intubation
C. Preservation of spontaneous Ablation of spontaneous
vs.
ventilation ventilation
4. Develop primary and alternative strategies.
A. Awake Intubation B. Intubation Attempts after Induction
of General Anesthesia

Airway approached by Airway secured by

* Initial intubation Initial intubation attempts
noninvasive intubation invasive access attempts UNSUCCESSFUL
successful* FROM THIS POINT ONWARD
* CONSIDER:
Succeed FAIL 1. Calling for help.
2. Returning to spontaneous ventilation
Cancel Consider feasibility Invasive airway 3. Awakening the patient
a a*
Case of other options access

Face mask ventilation adequate Face mask ventilation not adequate

Consider/attempt LMA

*
LMA adequate LMA not adequate or not feasible

Nonemergency Pathway Emergency Pathway

Ventilation adequate, intubation unsuccessful Ventilation inadequate, intubation unsuccessful

c Call for help

Alternative approaches to intubation
e
Emergency noninvasive airway ventilation

* *
Successful intubation FAIL after multiple attempts Successful ventilation FAIL Emergency
invasive
airway
b* a d b*
Invasive airway ventilation Consider feasibility of other options Awaken patient access