Implementing Advanced Airway Management Techniques: Insights from the Canadian Airway Focus Group

The Canadian Airway Focus Group (CAFG) has recently updated its consensus-based recommendations for managing difficult airways, particularly in unconscious patients. This blog aims to highlight key findings and recommendations from their research, helping practitioners in the field of online therapy to improve their skills or encourage further research.

Key Recommendations from the CAFG

The CAFG’s updated guidelines emphasize several critical points for managing difficult airways:

• Use of Video Laryngoscopy (VL): Studies indicate that VL offers higher first-attempt and overall success rates compared to direct laryngoscopy. The CAFG recommends using VL with an appropriately selected blade type for all tracheal intubations.
• Limiting Attempts: If the first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation are maintained. However, total attempts should be limited to three or fewer before declaring failure and considering “exit strategy” options.
• Exit Strategies: For failed intubation, exit strategies in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA).
• Emergency Front-of-Neck Airway Access (eFONA): In a “cannot ventilate, cannot oxygenate” emergency, the CAFG recommends performing eFONA without delay using a scalpel-bougie-tube technique.
• Airway Lead Designation: The CAFG recommends that all institutions designate an individual as “airway lead” to help institute difficult airway protocols, ensure adequate training and equipment, and assist with airway-related quality reviews.

Why These Recommendations Matter

Managing difficult airways can be challenging and is often associated with high risks. The updated recommendations by the CAFG are based on the best available evidence and expert consensus, aiming to enhance patient safety and improve outcomes. Practitioners can benefit significantly by incorporating these guidelines into their practice, thereby reducing the incidence of complications associated with difficult airway management.

Encouraging Further Research

While the CAFG’s recommendations provide a robust framework, ongoing research and training are essential for continual improvement. Practitioners are encouraged to stay updated with the latest developments and participate in further research to refine and enhance airway management techniques.
To read the original research paper, please follow this link: Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient.