Difficult Airway Management

Author: Jonathan Jones / Editor: Steve Fordham / Reviewer: Mohamed Elwakil, Jia Luen Goh / Codes: / Published: 10/05/2021 / Reviewed: 13/11/2025

This module covers the recognition and management of potentially difficult airway scenarios, including appropriate equipment preparation and strategy development for failed intubation.

By the end of this session you will be able to:

• Judge when an airway may be difficult or may become difficult
• Prepare the equipment that may be necessary
• Rehearse a strategy for failed intubation
• Plan a clear process for managing ”can’t intubate/can’t oxygenate (CICO)” situations

References

1. Brown CA, III, Sakles JC, Mick NW, et al. The Walls Manual Of Emergency Airway Management, 6e. Lippincott Williams & Wilkins, a Wolters Kluwer business; 2023. Accessed October 29, 2025.
2. Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location. J Clin Anesth. 2004 Nov;16(7):508-16.
3. Nee PA, Benger J, Walls RM. Airway management. Emerg Med J. 2008 Feb;25(2):98-102.
4. Nickson C. Airway Assessment. Life in the Fast Lane, 2024.
5. Ollerton JE, Parr MJ, et al. Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department–a systematic review. Emerg Med J. 2006 Jan;23(1):3-11.
6. Kheterpal S, Han R, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006 Nov;105(5):885-91.
7. Langeron O, Masso E, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000 May;92(5):1229-36.
8. Moseley C, Cadogan M, Mallampati Score. Life in the Fast Lane, 2022.
9. Levitan RM, Everett WW, Ochroch EA. Limitations of difficult airway prediction in patients intubated in the emergency department. Ann Emerg Med. 2004 Oct;44(4):307-13.
10. Burtenshaw A, Benger J, Nolan J, editors. Emergency Airway Management. 2nd ed. Cambridge: Cambridge University Press; 2015. ISBN: 9781107707542
11. Yentis SM. Predicting trouble in airway management. Anesthesiology. 2006 Nov;105(5):871-2.
12. Nickson C. Direct versus Video Laryngoscopy. Life in the Fast Lane, 2024.
13. Weingart S. EMCrit 94 Debate: Has Video Laryngoscopy Killed the Direct Laryngoscope? Podcast. EMCrit. March 3, 2013.
14. Higgs A, McGrath BA, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth [Internet]. 2018 Feb;120(2):32352 [cited 2025 Oct 29].
15. Algorithm from Difficult Airway Society (DAS). Guidelines for the management of tracheal intubation in critically ill adults, 2017. [cited 2025 Oct 29].