Airway Trolley

In an airway emergency it is paramount that the right equipment is immediately available. The best way to ensure rapid access to difficult airway equipment is to keep it in an airway trolley. This is advocated in several published analyses of airway critical incidents including NAP4.

An example is shown below: from The Royal North Shore Hospital Intensive Care Unit.

The trolley has been ergonomically designed to be used in an ICU bedspace. The swing arm on the VL screen allows it to be positioned above the patient’s chest. The bronchoscope screen can also be viewed at the same time in cases where both devices need to be used together (for example, the VAFI and FARSI techniques).

The trolley has 4 drawers corresponding to Plans A, B, C and D of the Difficult Airway Society algorithm. The symbols used to depict these plans are from the Vortex cognitive aid.

• Plan A, Endotracheal Tube: contains all the equipment necessary for intubation by laryngoscopy.
• Plan B, Supraglottic Airway Device, SAD: contains first and second-generation SADs (i-gels) for airway rescue. If circumstances allow (i.e the patient can be oxygenated via the SAD, and it is thought appropriate), the SAD can be converted to an endotracheal tube with the use of the bronchoscope, with or without the Aintree Intubating Catheter (AIC). The AICs and bronchoscopes are located in the side baskets.
• Plan C, Facemask: contains facemasks, nasopharyngeal and oropharyngeal airways of various sizes.
• Plan D, Neck rescue) contains equipment for cannula, surgical and Seldinger cricothyroidotomy techniques. It also contains an Airway Exchange Catheter and Staged Extubation Kit.

For Intensive Care and Emergency clinicians, the goal is almost always endotracheal intubation. We appreciate that this is not the case in the operating department, where a SAD may be the first choice. The drawers are arranged in the order outlined above for the sake of standardisation.

On the side of the trolley is a file containing the airway cognitive aids.