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Cited by 2,214Airway Management and Intubation TechniquesTracheal and airway disordersAnesthesia and Sedative Agents

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

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Frerk, C., Mitchell, V.S., McNarry, A.F., Mendonca, C., Bhagrath, R., Patel, A., O’Sullivan, E.P., Woodall, N.M. +1 more·2015·British Journal of Anaesthesia
DOI 10.1093/bja/aev371PMC PMC4650961
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Abstract

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

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  • The 2015 Difficult Airway Society guidelines recommend that the scalpel-bougie technique is the technique of choice for front of neck airway.

    “and that the scalpel-bougie technique is the technique of choice.89”

    From Airway Management in Trauma (2018) · cites this paper as [89]

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Authors
Frerk, C., Mitchell, V. S., McNarry, A. F., Mendonca, C., Bhagrath, R., Patel, A., O’Sullivan, E. P., Woodall, N. M., & Ahmad, I.
Affiliations
  • Northampton General Hospital (GB)
  • University College London Hospitals NHS Foundation Trust (GB)
  • NHS Lothian (GB)
  • University Hospital Coventry (GB)
  • St Bartholomew's Hospital (GB)
  • Royal National Throat Nose and Ear Hospital (GB)
  • St. James's Hospital (IE)
  • Norfolk and Norwich University Hospital (GB)
  • Guy's Hospital (GB)
Corresponding author
Frerk, C.
ORCID
Venue
British Journal of Anaesthesia
Publisher
Elsevier BV
Published
2015-12
Volume
115
Issue
6
Pages
827-848
ISSN
0007-0912 (ISSN-L)
DOI
10.1093/bja/aev371
PMC
PMC4650961
OpenAlex
W2173578770
Cited by
2,214
References
2
Citations by year
2026: 164 · 2025: 199 · 2024: 162 · 2023: 208 · 2022: 240 · 2021: 209 · 2020: 290 · 2019: 228 · 2018: 194 · 2017: 166 · 2016: 141 · 2015: 6 · 2013: 1 · 2012: 1
FWCI
203.24
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Anaesthesia (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Royal College of Anaesthetists
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords
difficult airway, endotracheal intubation, rapid sequence induction, failed intubation, supraglottic airway devices, video-assisted intubation, fiberoptic intubation, cricothyroidotomy, preoxygenation, airway management algorithms, emergency airway management
MeSH terms
Humans, Practice Guidelines as Topic, Airway Management

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