In this session we will examine the fundamentals of the pre-hospital airway from airway assessment all the way through to the difficulties posed in practice. We will also look at the management from a stepwise concept all the way through to the use of invasive surgical techniques to manage the airway. We will also examine some of the optimal methods used to monitor the respiratory effort and when and when not to intervene. We will also examine the current utility and debate around Direct Laryngoscopy (DL) and Video Laryngoscopy (VL) and whether VL is around to stay within practice.

To do this I have with me John Chatterjee. John is a consultant anaesthetist with an interest in pre-hospital care and difficult airway, thoracic and high-risk anaesthesia. He has worked with and educated clinicians around the world in various ambulance and hospital services including places like New Zealand, Sydney, Liberia, Ethiopia, Ukraine and in the UK where he has worked with HEMS and BASICS. John is as an anaesthetist at Guys and St Thomas', and a Consultant with London's Air Ambulance at the Royal London. In the episode we examine:

The challenges of the pre-hospital airway
How to assesses the difficulty of an airway from sight and brief assessment
Declaration of the findings and plan
VL vs DL and where VL is going from a SOP and utilisation tool.
Stepwise management and understanding where to come in on the management plan.
Assessment of respiratory effort
Thoughts on RSI compared to retrospective practice.
Tips on surgical airways
Seminal airway research in the last 10 years – Impact Brain Apnoea
Seminal cases that John has learnt a lot from
Final thoughts from John and take-home messages.

John mentions these two papers within the conversation:

Difficult Airway Society (DAS) 2015 guidelines for management of unanticipated difficult intubation in adults:

https://aimeairway.ca/userfiles/26556848_Difficult_Airway_Society_2015_guidelines_for_management_of_unanticipated_difficult_intubation_in_adults.pdf

Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians

https://academic.oup.com/bja/article/113/2/220/1745948

My thanks to John for an insightful and engaging conversation.

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