Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

Years ago I somehow got involved in a project called the Vortex Approach . A cognitive aid concept created by Melbourne anaesthetist Dr Nicholas Chrimes that aimed to improve doctors recognition and management of DIFFICULT AIRWAYS & in particular the Cannot Intubate Cannot Oxygenate scenario .

A group of us pooled money to create a phone app whilst Nick created a website and designs out of his own money . Nick has now evolved the concept to the point it is nationally and internationally recognised and his designs and teaching appear in many of the rural and tertiary hospitals across Australia . He has also established a Safe Airway society in Australia .

As you can see from the video above of Dr Ben Mckenzie telling the tragic story of his son Max suffering anaphylaxis & ensuing hypoxic cardiac arrest , CICO deaths still occur in Melbourne , the home of the Vortex approach. 2 emergency physicians , 1 anaesthetist & 1 intensivist encountered CICO arrest with Max , not in a small rural ED but in a tertiary hospital ED with ECMO service . Yet the decision to perform surgical airway wasnt made until Max’s father arrived and told them to do it and had to help perform it. Within 2 minutes of tracheal intubation via surgical airway, ROSC was achieved but it was far too late by then.

I think Vortex Approach is a great cognitive aid but clearly more work needs to be done in the fight against airway deaths . Decades on from anaesthetic airway death of Elaine Bromiley , after published expert guidelines like DAS , after Vortex approach, CICO deaths still keep happening .

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