The Vortex Approach

The Vortex Approach is a cognitive aid tool created by Dr Nicholas Chrimes, consultant anaesthetist in Melbourne, Australia. It provides a simple and consistent template for airway management and can be used as a complement to other guidelines.

As you learnt in the previous step, guidelines are useful to devise a safe airway management plan and The Vortex helps transitioning to the actualisation of the plan. It can also be used for training, as well as during both elective and emergency situations. It is relevant for all healthcare professionals, irrespective of their clinical background or their speciality, and can be used in any context in which an airway management takes place.

Many algorithms have been developed for management of the difficult airway but in stressful situations these may not easy to follow. In addition, they tend to emphasise intubation, rather than oxygenation of the patient and focus on the role of the anaesthetist, rather than the wider multi-disciplinary team.

Overview of The Vortex Implementation tool. ©Nicholas Chrimes

In the Vortex tool there are only three upper airway ‘lifelines’ (non-surgical techniques) for delivery of oxygen to the alveoli:

1. Face Mask

2. Supraglottic Airway

3. Tracheal Tube

Three failed attempts with ‘best effort’ at each of these three lifelines take you in a downwards spiral to the centre zone of the Vortex, the can’t intubate can’t oxygenate situation and the need to initiate ‘CICO rescue’ (emergency front of neck airway).

Success with any of the three lifelines, results in outward movement into the ‘green zone’, where oxygenation is adequate.

The tool emphasises the need to move to a different lifeline, when one has failed, and prompts the decision to attempt a front of neck airway when ventilation with a facemask, supraglottic airway and tracheal tube have failed. The circular arrangement of the three lifelines on the tool means that airway management can start with any one of the three and proceed to the others in whichever order is most appropriate in the clinical situation.

3D Model of The Vortex, ©Nicholas Chrimes

Have a look at the free educational and learning resources available on The Vortex Approach website, and in the next step watch the video demonstrating the Vortex in Action. In Week 4 you will learn how The Vortex has been incorporated into the DAS Guidelines for Intubation of the Critically Ill.