The Vortex Approach is another game changer in airway management. This podcast features Dr. Nicholas Chrimes reviewing this technique to manage the airway. He also ties in some Star Trek in there (listen to the podcast to know who his favorite character is).
Let's talk first about the main diagram. If you are not at all familiar with the Vortex Approach, visit their page first. The first graphic shown above is the main one to know. It has the most information and reminds us that there are three lifelines: face mask ventilation, endotracheal intubation, and supraglottic airway. Although most will try to go in that order when managing an airway, the Vortex Approach shows no preference. It does however remind you that a maximum of three attempts with any of these should be performed with at least one attempt by the most experienced clinician. Unsuccessful best efforts escalates the airway further and gets closer to the CICO status. CICO stands for "Can't Intubate, Can't Oxygenate" and is pronounce "Ky-Koh" when said out loud.
Before we talk about CICO, let's discuss the Green Zone. When a patient is in this zone, this is the best time to prepare. Optimize the airway and the situation to the best of your ability. This may have started as an unanticipated difficult airway, but it does not have to stay that way. Use strategies from the Green Zone to facilitate as safe as an airway approach as possible. We discuss a good situation of when to use the Green Zone in the podcast.
What happens when the lifelines have failed? In comes CICO and similar to the CriCon scale, there are three stages. The two are different though whereas with CriCon2 all cases discuss potential surgical airway management and it ends with preparation. It does not specifically go into the steps that are CICO rescue. The CICO Status diagram is better to cover this part. However, in most patients this should be quick and not require much thought. Definitely train on this before you ever get in this scenario!
If you would like to read the paper (and it is definitely worth the read), click here for access. Next week we will finish the Vortex Approach with discussing its implementation. This is obviously a brief overview and a thorough visit to the Vortex Approach website is a must.
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