Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation

Marshall, Stuart; Pandit, J. J.

doi:10.1111/anae.13354

Cited by 61 publications

(49 citation statements)

References 32 publications

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“…We suggest that simplified aids for use in a crisis, when our ability to process information can be overwhelmed, are developed alongside more detailed aids and that the two should be viewed as complementary. The notion of two complementary methods of using cognitive aids was described by Reason29 and, more recently, used as an analogy to help understand how to approach a recently revised cognitive aid for use in difficult airway management by Marshall 30…”

Section: Discussionmentioning

confidence: 99%

Using simulation to iteratively test and re-design a cognitive aid for use in the management of severe local anaesthetic toxicity

2017

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IntroductionCognitive aids, such as a guideline for the management of severe local anaesthetic (LA) toxicity, are tools designed to help users complete a task. Human factors experts recommend the use of simulation to iteratively test and re-design these tools. The purpose of this study was to apply human factors engineering principles to the testing and iterative re-design of three existing cognitive aids used for the management of severe LA toxicity and to use these data to develop a ‘new’ cognitive aid.MethodsTwenty anaesthetist–anaesthetic assistant pairs were randomised into four groups. Each of the first three groups received one of three different existing cognitive aids during a standardised simulated LA toxicity crisis. Postsimulation semistructured interviews were conducted to identify features beneficial and detrimental to the format and usability of the aid. Synthesis of the interview data with established checklist design recommendations resulted in a prototype aid, which was subjected to further testing and re-design by the fourth group (five more pairs) under the same conditions thus creating the final iteration of the new aid.ResultsFeatures of the new aid included a single-stream flowchart structure, single-sided, large-font design with colour contrast, simplified instructions and no need for calculations. This simplified tool contains only the information users reported as essential for the immediate crisis management.ConclusionsUtilisation of formative usability testing and simulation-based user-centred design resulted in a visually very different cognitive aid and reinforces the importance of designing aids in the context in which they are to be used. Simplified tools may be more appropriate for use in emergencies but more detailed guidelines may be necessary for training, education and development of local standard operating procedures. Iterative simulation-based testing and re-design is likely to be of assistance when developing aids for other crises, and to eliminate design failure as a confounder when investigating the relationship between use of cognitive aids and performance.

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Section: Discussionmentioning

confidence: 99%

Using simulation to iteratively test and re-design a cognitive aid for use in the management of severe local anaesthetic toxicity

2017

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“…they do not tell us how to customise Plan A, for any given case). They are relevant only for when Plan A fails, regardless of what that Plan A is [3,4].…”

Section: S Mcafeementioning

confidence: 99%

Is Plan A OK in the ‘plausibly difficult’ airway? A reply

Pandit

Heidegger

2017

Anaesthesia

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“…Instead, using a binary pragmatic approach as we suggest, these patients are simply to be classed 'plausibly easy' and any SAD to hand could then be used. Only if it does not work well should it be pragmatically exchanged for another (type or size) [3], or in the rare event of true airway difficulty (despite signs of 'easy') then difficult airway algorithms applied [4,5].…”

mentioning

confidence: 99%

Airway assessment/management paradigm – does a spectral or a binary approach fit better? A reply

Pandit

Heidegger²

2017

Anaesthesia

Self Cite

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Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation

Cited by 61 publications

References 32 publications

Using simulation to iteratively test and re-design a cognitive aid for use in the management of severe local anaesthetic toxicity

Using simulation to iteratively test and re-design a cognitive aid for use in the management of severe local anaesthetic toxicity

Is Plan A OK in the ‘plausibly difficult’ airway? A reply

Airway assessment/management paradigm – does a spectral or a binary approach fit better? A reply

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