American Society of Anesthesiologists (ASA) difficult Airway Algorithm
American Society of Anesthesiologists (ASA) difficult Airway Algorithm - Flowchart The Difficult Airway and Emergency Airway Techniques The Difficult Airway and Emergency Airway Techniques
«Flowchart»

Suspected difficult laryngoscopy?

Suspected difficult laryngoscopy?

Suspected difficult laryngoscopy?

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Suspected difficult ventilation with face mask/supraglottic airway?

Suspected difficult ventilation with face mask/supraglottic airway?

Suspected difficult ventilation with face mask/supraglottic airway?

Any one factor alone
(assessed difficulty with
intubation,ventilation,or
aspiration or desaturation
risk) may be clinically
important enough to warrant
an awake intubation

Other patient factors may
required an alternative strategy

Any one factor alone
(assessed difficulty with
intubation,ventilation,or
aspiration or desaturation
risk) may be clinically
important enough to warrant
an awake intubation

Other patient factors may
required an alternative strategy

Any one factor alone
(assessed difficulty with
intubation,ventilation,or
aspiration or desaturation
risk) may be clinically
important enough to warrant
an awake intubation

Other patient factors may
required an alternative strategy










Yes

Yes

Yes

No

No

No

Proceed with intubation attempt

Proceed with intubation attempt

Proceed with intubation attempt

INTUBATION ATTEMPT AFTER INDUCTION OF GENERAL ANESTHESIA

INTUBATION ATTEMPT AFTER INDUCTION OF GENERAL ANESTHESIA

INTUBATION ATTEMPT AFTER INDUCTION OF GENERAL ANESTHESIA

Significant increased risk of aspiration?

Significant increased risk of aspiration?

Significant increased risk of aspiration?

Proceed with intubation attempt

Proceed with intubation attempt

Proceed with intubation attempt

Yes

Yes

Yes

No

No

No

OPTIMIZE OXYGENATION THROUGHOUT

OPTIMIZE OXYGENATION THROUGHOUT

OPTIMIZE OXYGENATION THROUGHOUT

INTUBATION ATTEMPT WITH PATIENT AWAKE

INTUBATION ATTEMPT WITH PATIENT AWAKE

INTUBATION ATTEMPT WITH PATIENT AWAKE

End

End

End

Awake intubation

Awake intubation

Awake intubation

Airway electively secured

by invasive access

Airway electively secured

by invasive access

Airway electively secured

Consider other options

Consider other options

Consider other options

SUCCESS

SUCCESS

SUCCESS

FAIL

FAIL

FAIL

Postpone the case

Postpone the case

Postpone the case

FAIL

FAIL

FAIL

Increased risk of rapid desaturation?

Increased risk of rapid desaturation?

Increased risk of rapid desaturation?

Yes

Yes

Yes

No

No

No

Suspected difficult emergency invasive airway

Suspected difficult emergency invasive airway

Suspected difficult emergency invasive airway

Yes

Yes

Yes

No

No

No

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<Next Node> < Proceed with intubation attempt Proceed Always evaluate for emergency invasive airway Always evaluate

LIMIT ATTEMPTS

consider calling for help

LIMIT ATTEMPTS

consider calling for help

LIMIT ATTEMPTS

consider calling for help

FAIL

FAIL

FAIL

SUCCESS

SUCCESS

SUCCESS

CONSIDER/ATTEMPT SUPRAGLOTTIC AIRWAY

CONSIDER/ATTEMPT SUPRAGLOTTIC AIRWAY

CONSIDER/ATTEMPT SUPRAGLOTTIC AIRWAY

NON-EMERGENCY PATHWAY

NON-EMERGENCY PATHWAY

NON-EMERGENCY PATHWAY

Ventilation adequate/intubation unsuccessful

Ventilation adequate/intubation unsuccessful

Ventilation adequate/intubation unsuccessful

Consider alternative intubation approaches

invasive access or the feasibillity of other options

Consider alternative intubation approaches

invasive access or the feasibillity of other options

Consider alternative intubation approaches

invasive access or the feasibillity of other options

EMERGENCY PATHWAY

LIMIT ATTEMPTS AND BE AWARE OF THE PASSAGE OF TIME
CALL FOR HELP/FOR INVASIVE ACCESS

EMERGENCY PATHWAY

LIMIT ATTEMPTS AND BE AWARE OF THE PASSAGE OF TIME
CALL FOR HELP/FOR INVASIVE ACCESS

EMERGENCY PATHWAY

LIMIT ATTEMPTS AND BE AWARE OF THE PASSAGE OF TIME
CALL FOR HELP/FOR INVASIVE ACCESS


SUCCESS

SUCCESS

SUCCESS

FAIL or deteriorating ventilation

FAIL or deteriorating ventilation

FAIL or deteriorating ventilation

End

End

End

Attempt alternative intubation approaches as you prepare for emergency invasive airway Attempt alternative Emergancy invasive airway Emergancy invasive airway

Emergency invasive airway

Emergency invasive airway

Emergency invasive airway

FAIL

FAIL

FAIL

SUCCESS

SUCCESS

SUCCESS

End

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<Next Node> < SUPRAGLOTTIC AIRWAY VENTILATION ADEQUATE SUPRAGLOTTIC SUPRAGLOTTIC AIRWAY NOT
ADEQUATE (Cannot intubate, cannot ventilate)
SUPRAGLOTTIC AIRWAY MASK VENTILATION ADEQUATE
AS CONFIRMED BT CO2
2 MASK VENTILATION ADEQUATE MASK VENTILATION NOT ADEQUATE MASK VENTILATION NOT ADEQUATE