Project for Universal Management of Airways: guidelines for providing a foundation for airway management

INTRODUCTION: Before commencing airway management in any individual patient, a foundation should be provided that establishes the capability of organisations, departments and practitioners to undertake all episodes of airway care safely and effectively. Components of this foundation include the environment; equipment; education; culture; and processes within an organisation. It is important to consider how the interaction between these elements and airway practitioners working in the system impacts individual and team performance. METHODS: An international, multidisciplinary working group reviewed existing airway guidelines and published literature. A structured process for generating expert consensus statements was undertaken, including consultation with an international advisory group comprising airway operators and assistants, as well as human factors experts. Discrepancies between the results of these two processes were analysed and reconciled. Guidelines were generated, and recommendations were categorised according to the American Heart Association classification system. RESULTS: These guidelines make recommendations to assist in providing an adequate foundation for airway management that are applicable independent of geography, practitioner background or the context for airway care. Key components of an adequate foundation for airway management include design of systems and clinical environments; availability of suitable and functional equipment and monitoring; training of airway practitioners in both the behavioural and procedural skills necessary for safe and effective performance; and promoting a patient-centred, fair and just, no-blame culture. Consultation with human factors experts is required to optimise the impact that interaction between these elements and airway practitioners has on individual and team performance. DISCUSSION: Providing an adequate foundation for airway management is fundamental to enabling all episodes of airway care to be undertaken safely and effectively. The principles outlined in this guideline are applicable across geographical boundaries, patient populations and clinical contexts in which airway management occurs.