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.

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.

ENT surgeon Georgie Harris and anaesthetist Drew Heffernan describe how they use high flow nasal oxygen to achieve tubeless airway surgery.

In this not-to-be-missed interactive session our hosts, Adam Rehak and Gerri Khong walk you through the good, the bad and the ugly of human factors in airway management. Using video footage of a highly realistic (tachycardia inducing) simulated airway emergency, the multi-stage case discussion canvases both audience responses and the input of a panel of human factors experts: David Brewster, Brooke Dench, Ben Meadley and Ian Summers, to illustrate that airway management is far more than just a technical skill. Instead, it will become clear that success is equally dependent on careful preparation, coordinated teamwork, precise communication and effective cognitive tools.

This session examines the psychological impact of critical airway incidents and explores processes to support resilience and wellbeing in teams dealing with adverse outcomes.

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A significant proportion of serious adverse airway events occur at extubation. In this session, an expert interprofessional panel emphasises that the timing, location and method of extubation requires careful consideration.

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Trading off competing risks can sometimes lead to “Perfect Plan Paralysis”. There may not be a perfect primary plan. In any case, all techniques have a failure rate. In this session, an expert interprofessional panel emphasises the critical importance of committing to and communicating a complete airway strategy: a coordinated series of plans including sequential contingencies for failure.

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Barriers to performing advanced airway management in the emergency department in Australia and New Zealand result in many unstable patients being transferred to the operating theatre at considerable risk. In this session, an expert interprofessional panel explores what is possible with existing resources, how we can buy time, and compares the ANZ system to that of other countries.

In this session, an expert interprofessional panel examines the decision making around how, when and where we manage patients presenting to the emergency department with evolving airway obstruction. Again the importance of thinking beyond patient factors is highlighted.

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What are the priorities and challenges in the pre-hospital management of the patient with a threatened airway? In this session, an expert interprofessional panel explores the impact of location, environment and skillset on decision making in airway management.

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Finding opportunities to learn or maintain airway skills, especially those infrequently encountered during clinical care, can be challenging, and even more so during a pandemic! In this session an expert interprofessional panel explores how to maximise learning opportunities and stresses the importance of being a lifelong learner in airway management.

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Airway management is a team sport. All members, not just the airway operator, are integral to safe and effective airway management. What teamwork skills are crucial to airway management and how do we teach them? In this session, an interprofessional expert panel discusses how we can optimise team training, with reference to both pre-hospital and in-hospital training programs.

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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.

Considering the complexities of our era, how do we best approach the acquisition and maintenance of airway skills? In this session, an interprofessional panel explores the teaching of core and specialised procedural airway skills to novices, trainees and experienced clinicians.

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SAS President Jon Gatward and Coda founder Roger Harris discuss the program for the upcoming SAS 2022 meeting on September 11th 2022 and the SAS/Coda Airway Workshops on Sept 12th 2022 at the Melbourne Convention and Exhibition Centre

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Intensive Care Paramedic and SAS Board member Matthew Humar interviews Dr John Glasheen, Aeromedical Retrieval Physician, about his study:

Successful endotracheal intubation following a failed first attempt during aeromedical retrieval (Emergency Medicine Journal 2020; 37: 314-8).

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?"