Safe Airway Society podcast

Nick Chrimes and Adam Rehak investigate this vexing issue which is still claiming lives around the world. Using clinical scenarios and the PUMA guidelines for the prevention of unrecognised oesophageal intubation, Nick and Adam will challenge your traditional thinking, aphorisms, dogmas and behaviour, so that it doesn't happen to you.

Andrew Robinson leads a discussion on this higly topical and somewhat controversial topic. Tim Cook, David Story, Erin Foulsham, Ben Olesnicky, Ruth Parsell and Phil Visser make up the interprofessional panel.

Internationally renowned human factors expert Victoria Brazil describes how a group of highly functioning individuals can become a high performance airway team.

SAS Secretary Adam Rehak and SAS President Louise Ellard welcome delegates to SAS 2023.

Recorded 12th January 2021

Full video livestream of all Airwaves Podcasts is available on the Safe Airway Society YouTube channel.

Despite video laryngoscopy now being a widely available tool for airway management, airway practitioners continue to debate its role, its benefit over direct laryngoscopy and the optimal technique for its use.

Host Nicholas Chrimes is joined by airway experts Tim Cook and George Kovacs to explore the evidence and controversies related to these issues.

Recorded 19th Jun 2023

Full video livestream of all Airwaves Podcasts is available on the Safe Airway Society YouTube channel.

In this episode we go back to basics to discuss the what is arguably the most important and difficult upper airway technique to master - facemask ventilation.

Host Nicholas Chrimes is joined by Pierre Bradley & Joanna Simpson to discuss why facemask ventilation is important, how to optimise it, how to document it and much more.

Useful Resources:

Facemask Ventilation article by Pierre Bradley in BJA Education: https://www.bjaed.org/article/S2058-5349(21)00126-8/pdf

Facemask Optimisations from the Vortex Approach: http://vortexapproach.org/lifelines#fmv

ANZCA Airway Assessment document: https://libguides.anzca.edu.au/ld.php?content_id=48533093

Articles on test facemark ventilation before giving muscle relaxants:

• Evaluation of changes in tidal volume during mask ventilation following administration of neuromuscular blocking drugs https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12677
• Could ‘safe practice’ be compromising safe practice? https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2007.05429.x
• Face-mask ventilation: the neglected essentials? https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14703
• Facemask ventilation before or after neuromuscular blocking drugs: where are we now? https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.12792
• Checking mask ventilation before neuromuscular block: A nation-wide survey of anaesthetists’ attitudes and thinking. https://onlinelibrary.wiley.com/doi/abs/10.1111/aas.13426 

Difficult Airway Alert Form: https://www.safercare.vic.gov.au/sites/default/files/2023-02/Victorian%20difficult%20airway%20alert%20and%20support%20document.pdf

Grading systems for outcome of facemask ventilation:

• Concord Scale - capnography grading scale for objective description of mask ventilation: https://www.sciencedirect.com/science/article/pii/S0007091217372094?pes=vorhttps://www.sciencedirect.com/science/article/pii/S0007091217372094?pes=vor
• Han Scale: https://pubs.asahq.org/anesthesiology/article/101/1/267/8519/Grading-Scale-for-Mask-Ventilation

Join SAS: https://www.SafeAirwaySociety.org/join

Recorded 17th January 2021

Full video livestream of all Airwaves Podcasts is available on the Safe Airway Society YouTube channel.

Use of a videolaryngoscope with a hyperangulated blade has the potential to allow easy intubation of patients in whom direct laryngoscopy might be difficult or impossible. However, learning the correct technique, which varies markedly from the technique for direct laryngoscopy, is crucial to yielding these benefits. In inexperienced hands, the hyperangulated blade may complicate even straightforward intubations.

Having performed around 6000 videolaryngoscopic intubations, anesthesiologist Richard Cooper is one of the world's leading experts in hyperangulated videolaryngoscopy. In this one hour session host Nicholas Chrimes invites him to take us step-by-step through the technique he has refined over the course of his career.

Recorded 9th Nov 2020

Full video livestream of all Airwaves Podcasts is available on the Safe Airway Society YouTube channel.

COVID-19 has challenged the way we conduct airway management. As well as being a source of anxiety, this has also pushed us to consider new approaches to our practice. 

In the first episode of Airwaves, host Nicholas Chrimes asks an expert panel “In relation to airway management, what have we learned about COVID and what have we learned from COVID?" 

Jon Gatward, SAS President, leads the acknowledgement of country and introduces SAS 2022.

Andy Higgs and Tim Cook describe the PUMA Prevention of Unrecognised Oesophageal Intubation Guidelines and their rationale.

Tim Cook uses individual cases and analysis of the systems, processes and human factors involved in unrecognised oesophageal intubation to investigate why this tragic occurrence is still a problem around the world. He offers us some tools and advice to prevent unregognised oesophageal intubation from happening in our practice.

In this session, MICA Paramedic Matthew Humar presents a local case of unrecognised oesophageal intubation; and using this case as a reference, discusses why this is an universal issue.

Are we safe when we intubate COVID-19 patients? Are CPAP, high-flow oxygen, and intubation AGPs? Two years into this pandemic, what should we be doing at work to keep ourselves safe? An international panel of experts present their research, emerging evidence and review current practice. Andy Shrimpton presents the game-changing AERATOR studies, Forbes McGain presents his experience with the ventilation hood and Jo Simpson reviews the historical evidence regarding AGPs and her work on aerosol containment devices.

Tim Cook brings the AGP session together with an overview of airways, aerosols and healthcare worker safety.

Anaesthetists Bill Bestic and Adam Pasfield describe and demonstrate the use of ketamine for fibre-optic intubation, including via supraglottic airway devices, in patients who may be non-compliant.

Anaesthetist Adam Rehak describes and demonstrates VAFI (video-assisted fibre-optic intubation) and FARSI (fibre-optic assisted rapid sequence induction), for the management of difficult and traumatised airways.

The mission of the Project for Universal Management of Airways (PUMA) is to create a single set of airway guidelines that provide consistent guidance for airway practitioners of any discipline, in any country, in any context. Following years of development, these guidelines will be released in six separate papers over the coming months. In this session, one of the authors, Andy Higgs, presents highlights of the project.

David Anderson describes the current state of play with airway management in the prehospital setting. There are important differences between airway management in the prehospital environment and airway management in hospital. Prehospital intubation has been practiced for over 50 years and continues to evolve, with many techniques and procedures devised from prehospital use finding their way into ED and ICU practice. The main indications for prehospital intubation are cardiac arrest and severe TBI. 3 large studies show no evidence to support prehospital intubation in cardiac arrest and this practice should probably be reserved for specific cases. Prehospital RSI for TBI remains controversial as the evidence available to date is conflicting and isn’t high quality. While scene time if often commented on, there is no evidence available prehospital RSI increases time to CT or OR for patients with a severe TBI. There is no evidence that any one craft group is better at intubation than any other. In order to make prehospital airway management as safe as possible, innovations such as checklists, kit dumps and pre-drawn syringes are common. Many prehospital services invest much more heavily in the training and maintenance of airway skills than in-hospital specialties.

David Brewster describes the current state of play with airway management in the critical care setting, including a summary of the INTUBE study and the Safe Airway Society guidelines for airway management in COVID-19 patients.