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The Vortex Approach is a circular graphic that helps clinical teams perform under pressure by providing a simple, consistent template for airway interventions. It is based on the premise that there are only three upper airway lifelines: face mask, supraglottic airway and endotracheal tube.
- Lifelines
The Vortex Approach allows clinicians the flexibility to...
- Green Zone
Many airway resources include reminders to "consider waking...
- Neck Rescue
The term 'priming' was coined for the Vortex Approach to...
- SAFE APNOEA TIME
Delaying desaturation by extending the safe apnoea time not...
- Planning
Following assessment of the patient, situation & clinician...
- Publications
The Vortex: a universal "high acuity implementation tool"...
- Contact
No remuneration, financial or otherwise, was received by the...
- Priming
The term 'priming' was coined for the Vortex Approach to...
- Lifelines
A Abordagem Vortex é um modelo simples, baseado em uma “ferramenta de alta acuidade” e predominantemente gráfico, especificamente projetada para ser usada durante a situação de alto risco e tempo crítico de uma emergência de via aérea em evolução.
Following assessment of the patient, situation & clinician factors impacting on airway management, developing any airway strategy requires addressing each of the domains of the primary Vortex Tool: the Green Zone, the upper airway lifelines & CICO Rescue.
- Comments by Senior Critical Care Physicians on the Vortex Approach
- Contents
- Terminology
- Introduction
- Goals of Airway Management
- The Unanticipated Difficult Airway
- Use of the Vortex
- Features of the Vortex
- The Green Zone:
- The Funnel:
- Emergency Surgical Airway
- Facilitating an Optimal Attempt to Achieve Airway Patency
- Assessing Airway Patency
- Confirming Airway Patency via a NSA
- Confirming Patency via an ESA:
- Airway Training Programs
- Conclusion
- Glossary
- Acknowledgements
- Monash Simulation
- Clinical Cred
I see the Vortex model as an advance on the current unidirectional algorithms advocated for difficult airway management – Dr Mark Adams: Director of Anaesthesia, Monash Medical Centre The Vortex describes the way I already think about difficult airway management but articulates it in a way that can be easily communicated to others – Dr Craig Walker...
Terminology Introduction Goals of Airway Management The Unanticipated Difficult Airway Overview of the Vortex Approach Use of the Vortex Features of the Vortex Emergency Surgical Airway Facilitating an Optimal Attempt to Achieve Airway Patency Assessing Airway Patency Airway Training Programs Conclusion Glossary Acknowledgements About the Authors O...
One of the challenges in discussing difficult airway management is that the precise meaning of even commonly used terms such as ‘apnoea’, ‘ventilation’, ‘oxygenation’, ‘surgical airway’ and even “difficult airway” itself, are subject to varying interpretation by different clinicians. The intended definitions of the key terms, as they are used in th...
In emergency situations, established clinical protocols are intended to help avoid fixation, facilitate teamwork and help ensure that time critical management options are not delayed or overlooked. Observations in both clinical & simulated settings, however, demonstrate that adherence to a guideline or protocol may be compromised in situations that...
The primary goal of airway management is ensuring alveolar oxygen delivery (AOD) is maintained. Achieving this requires both a patent airway and a mechanism for delivering oxygen to the alveoli. Patency can be achieved either non-surgically or surgically. There are three possible mechanisms to deliver oxygen to the alveoli via the patent airway: Ve...
The transition from the patient maintaining their own airway to the critical care physician using one of the above non-surgical techniques to support the airway, typically involves a decrease in the patient’s conscious state. This is associated with the potential for airway obstruction &/or apnoea to occur. Techniques which allow airway management ...
To view other resources relataing to the Vortex approach including a narrated presentation and videos of the Vortex being used in clinical practice, go to vortexapproach.com The Vortex model prompts the team to make an “optimal attempt” to achieve airway patency via each of the three NSA techniques. Whilst desirable, it may not be possible to have ...
In broad terms, the Vortex approach aims to facilitate a shared understanding amongst team members of 2 key aspects of emergency management of the FDA: Firstly, the Vortex model encourages the team managing the airway to use all three NSA techniques as efficiently as possible to determine whether patency via a NSA is attainable. Should progression ...
The “Green Zone” is conceptualised as a horizontal surface (Fig 11) to reinforce that once AOD is confirmed there is no imperative to move immediately onwards but instead an opportunity exists to pause and strategise. The best way to proceed will then be determined by the clinical situation, the availability of equipment and the skills of the team ...
The blue funnel component of the Vortex represents any point at which airway patency cannot be confirmed and there is a potential interruption to AOD. In contrast to the “green zone” this section is conceptualised as sloping in nature, to reinforce that during this phase there must be ongoing, efficient progression through each of the techniques to...
The performance of an ESA is an unfamiliar task performed under difficult circumstances, often in patients in whom the same anatomy which predisposed to the need for the ESA, makes its performance technically difficult. These problems may be compounded by the availability of multiple techniques and devices, selection of an inappropriate technique t...
As described above, up to three tries geared towards further enhancing conditions so that a patent airway might be achieved, can be had at each NSA technique in the process of having an “optimal attempt”. Having optimal attempts with each NSA technique requires an approach that is simultaneously efficient and rigorous to ensure that the best attemp...
Integral to the process of moving through the Vortex is the ability of the clinician to efficiently assess success or failure at each stage. This requires clarity about what is being assessed and the criteria that allow it to be confirmed. There has been a recent move towards favouring use of the term “oxygenation” as the crucial issue to be achiev...
In the absence of pulmonary pathology and equipment malfunction, when airway patency is achieved by any of FM, LMA or ETT, delivery of oxygen to the alveoli by positive pressure ventilation is always possible provided an adequate seal is present. Thus provided the cuff of the NSA device creates a proper seal, inability to achieve ventilation of the...
Insufflation of oxygen is the minimum requirement for AOD via an ESA. Whilst ventilation may be possible via an ESA it not required for AOD and need not be a goal at this stage of airway management. Ability to insufflate via an ESA is confirmed by the ability to deliver oxygen via a conduit placed directly into the trachea without occurrence of sur...
The Vortex approach is directed at addressing the emergency management of the unanticipated FDA. Effective airway training programs for critical care physicians are crucial to minimise the chances of this situation arising in the first place. The importance of thorough airway assessment, strategic airway planning/preparation, supervision, timely se...
The Vortex approach provides a simple framework for thinking about emergency management of the FDA. Rather than simply being a “new airway algorithm” it is comprised of a specific education program based around a simple conceptual model for decision making and reinforced by a straightforward cognitive tool. In combination these elements provide a c...
The authors recognise that in some cases the terms listed below, although commonly used, have no accepted strictly defined meaning whilst in others there may be ambiguities or technicalities which would allow legitimate alternate definitions by some clinicians. The definitions given below simply reflect the intended meaning of the respective terms ...
The authors would like to thank Jon Graham & Richard Haydon for their valuable contributions to the development of the Vortex cognitive tool. Thanks also to Jen Hogan, Anoushka Perera, Helen Kolawole and Jane Anderson for their assistance with the preparation of this text.
Put the healthcare techniques outlined in this e-book into practice in a realistic simulated clinical environment. More details available at Monash Simulation
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The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error.
- P. Charco-Mora, R. Urtubia, L. Reviriego-Agudo
- 2018
The Vortex Approach is a universal and context-independent method for airway management in emergencies. Find out how it is applied, evaluated and promoted in various publications, guidelines and resources.
The Vortex implementation tool is the core of the broader Vortex Approach which provides a comprehensive array of resources to facilitate all phases of airway advanced airway care including airway assessment, development of an airway strategy and performance of airway interventions in both the routine and emergency setting.
