The Vortex is a high stakes cognitive aid that provides a single universal template for difficult airway management which can be taught to all staff likely to be involved in airway crises. It is simple enough to be recalled in a crisis and flexible enough to be used in any context.

© Copyright Nicholas Chrimes & Peter Fritz, 2013. All materials on this site may be used for non-commercial purposes with acknowledgement of the authors & copyright holders.



The Airway Safety Lines (ASL) Strategy: the ASL strategy uses a simple visual representation to illustrate the way 3 separate, but related, pieces of content addressing management of the difficult airway fit together - and can be used to produce a coordinated difficult airway training program.

1. The NODESAT principles ‘buy time’ and help avoid critical desaturation whilst a non-surgical airway (NSA) +/- an emergency surgical airway (ESA) is being established.

2. The Vortex approach facilitates efficient establishment of a NSA where possible. It also promotes early recognition of the need for an ESA, when optimal attempts at all 3 NSA techniques are unsuccessful, and gives the team ‘permission’ to proceed to ESA.

3. The work of Andrew Heard clarifies the technical aspects of performing an ESA and stresses the need both for training in these techniques as well as ready availability of the equipment needed to perform them. It also provides a valuable pathway for management of the failed ESA.


Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine 2012; 59(3): 165-175

Chrimes N, Fritz P. The Vortex Approach: Management of the Unanticipated Difficult Airway. Monash Simulation, 2013.

Heard AMB, Green RJ, Eakins P. The formulation and introduction of a ‘can’t intubate, can’t ventilate’ algorithm into clinical practice. Anaesthesia 2009; 64: 601-608

Mac 3 vs Mac 4: Demonstration of the mechanical disadvantage of a longer blade