Human Factors in Airway Management

Stuart Marshall @hypoxicchicken

Quiet ‘Something needs to be done’Unfamiliar equipmentFailure of techniqueImprovisation

Teamwork, CommunicationStandard Procedures

Equipment designPersonal preparedness

Resilience

©HuZheng2012

NAP4 (BJA 2011)40% cases had HF failure (75 cases)

Flin et al (Anaesthesia 2013)100% cases had HF failure

Median of 4.5 failures per caseCommonest: ‘Task cognition’

and ‘Job factors’

Founda1onandPragma1csofCogni1veWorkAnalysis,Lintern,G.2009

“Trying to understand safety by only looking at incidents is like trying to understand sharks by only looking at shark attacks”

Professor Bob WearsED physician and HF researcher

Share the generic and specific planUse team promptsWalkthrough or time outCognitive aids for situation

Improving your Decision Making

Stuart Marshall @hypoxicchicken

HF affects airway managementUnderstand decisions

Redesign all aspects

References:-Cook, T. M., Woodall, N., & Frerk, C. (2011). Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British Journal of Anaesthesia, 106(5), 617-631. -Flin R Fioratou E Frerk C et al. (2013). Human factors analysis of airway incidents. Anaesthesia, 68, 817–825. -Schnittker R, Marshall SD Safe anaesthetic care: Further improvements require a focus on resilience. British Journal of Anaesthesia 2015; 115: 643-5.-Lintern G. The Foundations and Pragmatics of Cognitive Work Analysis: A Systematic Approach to Design of Large-Scale Information Systems. Melbourne, 2009: 124.-Hollnagel E, Paries J, Woods DD, Wreathall J (eds). Resilience engineering in practice: A guidebook. Farnham: Ashgate; 2011.-Frerk C, Mitchell V, McNarry A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia 2015; 115: 827–48.-Marshall SD Use of cognitive aids during emergencies in anesthesia: A systematic review. Anesthesia and Analgesia 2013; 117: 1162-71.-Marshall SD, Pandit JJ A radical evolution: the 2015 Difficult Airway Society Guidelines for managing unanticipated difficult or failed intubation. Anaesthesia 2016; 71: 131-7.

Acknowledgements:Many thanks to Gavan Lintern for sharing his expertise and deep insights on CWA.Raphaela Schnittker for her ongoing work into decision making in airway managementMembers of the ‘Airway Illuminati’ for sharing ideas, friendship and inspirationCountless anaesthetists and anaesthetic nurses for freely giving their time for interviews

Slide Photograph credits:Slide 1 and 8 Ryan McGuire, gratisography.comSlide 2 ‘Stop Believing’ by Gabriela Camerotti (Flickr)Slide 3 ‘Game of life’ by Hu Zheng from http://zhenghu.cgsociety.orgSlide 4 Model of CWA by Gavan Lintern (reference 4)Slide 5 EPA/World Surf LeagueSlide 6 Modified from a Hubble telescope image by Abroudjameur after NASA (Flickr), Slide 7 NASA archive