Abandoning difficult airway algorithms to improve patient safety | Rich Levitan

A talk by Rich Levitan from TBS23


A talk by Rich Levitan at The Big Sick 2023 conference. Kindly shared with permission.
See the TBS23 landing page for the programme and full set of talks.


Airway algorithms, and difficult airway prediction, have been promoted for thirty years as means to improve patient safety and structure airway education. This lecture will argue that its time to move on, to teach priorities and crisis performance instead of prediction and algorithms. Algorithms are not how clinicians actually practice, they are not appropriate across all settings with differing skill sets, and may actually worsen performance by adding to operators’ cognitive burden. Prediction of difficult direct laryngoscopy is of minimal value in an era of video laryngoscopy and highly effective supraglottic airways. The principal priority in airway management is oxygenation, followed by avoidance of hemodynamic instability and aspiration. This talk will present engineered solutions focusing on these priorities, in order to improve crisis performance in emergency airways.


Until we have final edits ready the video below is straight from the livestream. Expect a few audio issues and other glitches here and there.




Attending Physician, Emergency Dept., Littleton Regional Hospital


Dr. Levitan was in the first class of Emergency Medicine residents at Bellevue Hospital in NYC (1990-1994). Frustrated with his training and skills in emergency airway management, he began a thirty year obsession with airway imaging, research, and education. He worked at inner city level 1 trauma centers in NYC (Bellevue, Lincoln Hospitals) and Philadelphia (Penn, Einstein, Jefferson) for twenty three years before working for ten years at critical care access hospital in rural New Hampshire amd Colorado.. He regularly teaches airway procedure courses about the US and around the world, and is perhaps best known for his monthly Baltimore cadaver course, which ran monthly for twenty years. He has developed airway devices and holds approximately twenty patents. He did initial lab investigations and product development of many products now in widespread use, specifically the I-gel, the AMBU A-Scope, the I-View. He pioneered and studied many airway techniques now in common practice including: epiglottoscopy, bimanual laryngoscopy, ear-to-sternal notch positioning, the laryngeal handshake, and nasal oxygenation during efforts securing a tube (NO DESAT). When not looking at the larynx he likes being in the mountains.


Email: [email protected]

Twitter: @airwaycam

COI declared


Mads Astvad
 | Website

Scandinavian paediatric anaesthetist / intensivist.
Digital MedEd
Co-founder scanFOAM.org
Co-organiser CphCC & TBS-Zermatt (aka The Big Sick)
Medical lead REPEL (resilience in pediatric emergency life support)
Web dev SSAI.info

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