Daily News Boston CHEST 2024

October 6-9, 2024

How to rescue the failed airway

New this year, CHEST is offering a slice of its normal three-day airway simulation courses at the annual meeting by breaking down the course into several ticketed sessions.

  • Airway Management on Cadavers
  • New Tools for Difficult ICU Airway Management
  • Adding Ultrasound to Airway Management Crisis
  • The CHEST Approach: Skills for Effective ICU Airway Management
  • Critical Skills for Failed Airway Management

The new Critical Skills for Failed Airway Management course will focus on where to turn when all the regular procedures don’t work, said Thomas M. Fuhrman, MD, MS, FCCP. The session starts Sunday at 2:30 pm in the convention center’s Hemisphere Ballroom.

“We will start with reviewing normal intubation, and then go to the next best options if that doesn’t work,” said Dr. Fuhrman, noting the session is designed for pulmonary fellows, pulmonologists, respiratory therapists, nurses, and ER physicians.  “If you’re unable to do a normal intubation with a normal laryngoscope, what’s your next best option? You’ll probably go with a video laryngoscope. And if you really can’t see well, or if someone has something abnormal about their airway, or it’s not working, where do you go next?”

The session will review a number of important rescue tools, including cricothyrotomy, extraglottic airway (EGA) placement, and bag-mask ventilation.

While not usually thought of as a rescue technique, “Bag-mask ventilation is part of the initial and most important things you do during an intubation procedure,” he said. “You want to oxygenate people before you even attempt one of these procedures. You can’t do it forever, but if you can ventilate them and oxygenate them with a mask and a bag, then you have more time to decide what to do next.”

Dr. Fuhrman said they will review cricothyrotomy, a surgical procedure, and how to assemble cricothyrotomy kits, but it is very rarely done and considered a “last-ditch effort.” Cricothyrotomy involves making an incision through the skin and cricothyroid membrane to establish an airway and many clinicians are hesitant to cut into the neck.

The session will take a team-based learning approach to teach attendees about the importance of being a team leader and assigning roles, but also to stress the importance of communicating and working together.

“When everything goes perfectly fine, an intubation will take only a couple of minutes,” he said. “But with a failed airway, you could be in there for quite a while. If you’re not working together as a team, your patient is not going to make it.  The simulation part of this session gets attendees into this thinking. We also will interfere with the team to let them see what happens when one of their team members pays no attention to everybody else or is talking on a cell phone to show them how things cannot work well if everybody is not on the same page.”

Dr. Fuhrman said the workshop will include time reviewing scenarios and debriefing the course to recap what was done and evaluate what could have been improved.