Slides presented at the Australian and New Zealand College of Anaesthetists Annual scientific meeting, Auckland May 2016

1. Human Factors in Airway Management
Stuart Marshall @hypoxicchicken

2. Quiet
‘Something needs to be done’
Unfamiliar equipment
Failure of technique
Improvisation
Teamwork, Communication
Standard Procedures
Equipment design
Personal preparedness
Resilience

3. ©Hu Zheng 2012
NAP4 (BJA 2011)
40% cases had HF failure
(75 cases)
Flin et al (Anaesthesia 2013)
100% cases had HF failure
Median of 4.5 failures per case
Commonest: ‘Task cognition’
and ‘Job factors’

4. Founda1on and Pragma1cs of Cogni1ve Work Analysis, Lintern, G. 2009

5. “Trying to understand safety by only looking at
incidents is like trying to understand sharks by
only looking at shark attacks”
Professor Bob Wears
ED physician and HF researcher

7. Share the generic and specific plan
Use team prompts
Walkthrough or time out
Cognitive aids for situation
Improving your
Decision Making

8. Stuart Marshall @hypoxicchicken
HF affects airway management
Understand decisions
Redesign all aspects

9. References:
-Cook, T. M., Woodall, N., & Frerk, C. (2011). Major complications of airway
management in the UK: results of the Fourth National Audit Project of the Royal
College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British
Journal of Anaesthesia, 106(5), 617-631.
-Flin R Fioratou E Frerk C et al. (2013). Human factors analysis of airway incidents.
Anaesthesia, 68, 817–825.
-Schnittker R, Marshall SD Safe anaesthetic care: Further improvements require a focus
on resilience. British Journal of Anaesthesia 2015; 115: 643-5.
-Lintern G. The Foundations and Pragmatics of Cognitive Work Analysis: A Systematic
Approach to Design of Large-Scale Information Systems. Melbourne, 2009: 124.
-Hollnagel E, Paries J, Woods DD, Wreathall J (eds). Resilience engineering in practice:
A guidebook. Farnham: Ashgate; 2011.
-Frerk C, Mitchell V, McNarry A, et al. Difficult Airway Society 2015 guidelines for
management of unanticipated difficult intubation in adults. British Journal of
Anaesthesia 2015; 115: 827–48.
-Marshall SD Use of cognitive aids during emergencies in anesthesia: A systematic
review. Anesthesia and Analgesia 2013; 117: 1162-71.
-Marshall SD, Pandit JJ A radical evolution: the 2015 Difficult Airway Society Guidelines
for managing unanticipated difficult or failed intubation. Anaesthesia 2016; 71: 131-7.

10. Acknowledgements:
Many thanks to Gavan Lintern for sharing his expertise and deep insights on CWA.
Raphaela Schnittker for her ongoing work into decision making in airway management
Members of the ‘Airway Illuminati’ for sharing ideas, friendship and inspiration
Countless anaesthetists and anaesthetic nurses for freely giving their time for interviews
Slide Photograph credits:
Slide 1 and 8 Ryan McGuire, gratisography.com
Slide 2 ‘Stop Believing’ by Gabriela Camerotti (Flickr)
Slide 3 ‘Game of life’ by Hu Zheng from http://zhenghu.cgsociety.org
Slide 4 Model of CWA by Gavan Lintern (reference 4)
Slide 5 EPA/World Surf League
Slide 6 Modified from a Hubble telescope image by Abroudjameur after NASA (Flickr),
Slide 7 NASA archive