Key Learning Points

1. 1. Poor airway assessment and planning and failure to follow guidelines were highlighted as major issues in the Royal College of Anaesthetists 4th National Audit Project (NAP4). A lack of equipment was identified as an issue particularly prevalent in the intensive care environment.

2. 2. Factors which enable prediction of a difficult airway should be assessed for early to allow appropriate forward planning.

3. 3. It is important to have a well-organised, appropriately stocked and signposted difficult airway trolley, with regular teaching and updates to ensure all staff groups are familiar with the equipment.

4. 4. Thorough knowledge of the Difficult Airway Society’s guidelines on how to manage an unpredicted difficult airway in adults is essential. As of 2018, these include one specific to the intensive care unit – ‘Guidelines for the management of tracheal intubation in critically ill adults’.

5. 5. One must be able to appreciate the differences in emergency management of a tracheostomy (with a patent upper airway) and a laryngectomy (without a patent upper airway).

Key Learning Points

• Emergency cannula cricothyroidotomies are associated with high failure rates.

• Airway management in an emergency or a remote location is associated with a higher risk of complications.

• Anatomy of the neck is key to success in oxygenating via emergency front of neck access.

• There is now a single recommended technique for performing emergency cricothyroidotomy agreed by both surgeons and anaesthetists.