Peter Fritz and Nick Chrimes from Melbourne have just released a groundbreaking new concept in airway management. Utilising a cognitive aid as opposed to a traditional flowchart algorithm, and a short checklist, the Vortex approach to unanticipated difficult airway management is designed to be easy to remember and implement, to be used by any critical care specialty, and to provide a much easier to remember method to manage this traditionally high stress situation. As Peter said to me, “3 year old could look at it, walk away and draw it”. From an RRM perspective, the Vortex approach gives you a single image to picture in your mind rather than multiple steps in an algorithm (much easier to visualise when the pressure and distraction of a difficult airway presents itself), it facilitates group communication, it enables the group to offer alternative suggestions to the airway doctor, and it uses a checklist for optimization methods.
Having only just been released, the concept is already gaining massive traction, with the guys being interviewed on Minh Le Cong’s hugely popular PHARM Podcast. They have also started their own site, (in direct antagonism of my dislike for the word “crisis”!), Clinical Crisis Education which has links to CrisisPoint, a discussion area for critical care and resus issues, and their main Vortex site.
In my humble opinion the Vortex is much easier to remember than a flowchart, it changes the focus from “get the tube in” to “get the alveoli oxygenated”, it makes you consider a surgical airway from the very start, and it also includes the “green zone” – a type of Resus Time Out – which is when oxygenation has been achieved, regardless of the method, thereby allowing the team to stop, re-consider their options and make a safe plan, rather than ploughing on with repeated attempts at airway instrumentation.
I think the Vortex approach to the unanticipated difficult airway is great, and will surely make what was renowned as one of the more stressful experiences you can have in medicine easier to manage. You can follow Pete (@pzfritz) and Nick (@nicholaschrimes) on Twitter, and there are plans afoot to make the Vortex widely available, with online and face-to-face teaching.
What do you think of the Vortex? Is a cognitive aid better than a flowchart? Are there other parts of resus you could use them in?